Marlyn Conti , BSN, MM, CPHQ Patient Safety Initiatives Manager Intermountain Healthcare

1. Intermountain-led CMS Hospital Engagement Network Pressure Ulcer PreventionJune 24, 2014 Affinity Call Marlyn Conti , BSN, MM, CPHQ Patient Safety Initiatives Manager Intermountain Healthcare

2. Outline for Discussion • Review of the HEN Pressure Ulcer work • “Just-one-thing” Recommendations • High performers • 2014 plans for improvement:

3. Overall Progress Through Q1 2014

4. Intermountain HEN 2012-Q1 2014 Pressure Ulcer PSI 3

5. Intermountain HEN 2012-Q1 2014 Pressure Ulcer PSI 3

6. Intermountain HEN 2012-Q1 2014 Pressure Ulcer >= Stage 3

7. Intermountain HEN 2012-Q1 2014 Pressure Ulcer >= Stage 3

8. Intermountain HEN 2012-Q1 2014 Pressure Ulcer >= Stage 2

9. Intermountain HEN 2012-Q1 2014 Pressure Ulcer >= Stage 2

10. Intermountain HEN 2012-Q1 2014 Pressure Ulcer Prevalence

11. Intermountain HEN 2012-Q1 2014 Pressure Ulcer Prevalence

12. Just One Thing MatrixRecommendations

13. High Performing Hospital Highlight…Pressure Ulcer PSI 3

14. High Performing Hospital Highlight… Pressure Ulcers >= Stage 3

15. High Performing Hospital Highlight… Pressure Ulcers >= Stage 2 • *Most Improvement • Only 2 Hospitals have Reported Q1 2012 and Q 1 2014 data

16. High Performing Hospital Highlight… Pressure Ulcers Prevalence – All stages

17. Practice Survey • Do you have a pressure ulcer prevention team? Yes/No • If yes, Is your team multidisciplinary? Yes/No • If yes, how frequently do they meet? • Do they have resources to collect/interpret/review data? • Comments (free text) • What tools do you use to assess and properly stage a pressure ulcers? (free text) • Posters, fact sheets, etc, other (free text)

18. Practice Survey • Do you have skin and/or pressure ulcer assessment prompts embedded in your EMR? Yes/No • If yes, how often are they reported or prompted • Who receives the reports • What are the expected actions • To determine if reassessing patients at established frequencies • What is the one intervention that has had the most impact in reducing pressure ulcers? (free text) • What is the most innovative approach to reducing pressure ulcers?

19. Pressure Ulcer Scenario 9 M/O female infant with congenital anomalies requiring tracheostomy with an un-cuffed trachplaced.  Secretions were very difficult to manage and the MD indicated that re-intubation would be ‘impossible’ for this baby.  Trachties were very tight in order to hold the tube in place. The first trach change was performed 7 days after the initial placement and a stage IV pressure ulcer was found from the trach ties. What could have been done??

20. Pressure Ulcer Scenario 40 Y/O male, admitted with altered level of consciousness related to hepatic encephalopathy, hypotension and abdominal ascites. Patient had several large volume paracentesisperformed with rapid re-accumulation of fluid. The decision was made by the physician and the patient's mother to provide comfort measures only and the patient was transferred to inpatient hospice. 4 days after hospice transfer, a stage III pressure ulcer was found on his coccyx. • What this preventable? • What would you have done??

21. 2014 plans for improvement • Collect and share best practices across our network hospitals & system in a single document • Share practice bundles?