Best Practices in Home Care: Pressure Ulcer Prevention

1. Best Practices in Home Care: Pressure Ulcer Prevention

2. Background of the Pressure Ulcer Prevention Initiative • The importance of quality in wound management has never been greater with the implementation of OASIS C. • Since the Fall of 2011, a total of four wound-associated items, three of which are related to Pressure Ulcers, have been publicly reported on the Home Health Compare Website. • Utilizing the Home Health Compare website, CMS is informing healthcare consumers of homecare agencies that conduct pressure ulcer risk assessment, communicate with physicians to obtain orders for pressure ulcer prevention and implement measures to reduce the development of pressure ulcers.

3. Pressure Ulcers Incidence in St. Luke’s Home Health Patients • Higher incidence of Increase in the Number of Pressure Ulcers • Chart audits revealed • Pressure ulcers possibly missed at SOC • Other wound etiologies mistakenly labeled as pressure ulcers • Inconsistent documentation of interventions for patients determined to be at risk based on the Braden Scale

5. Problem The VNA of St. Luke’s Home Health patients experienced a higher incidence of developing pressure ulcers compared to the national reference Aim The VNA of St. Luke’s Home Health incidence of pressure ulcers will be lower than the national reference by April 2010

6. Our PI Team • Two Wound Care Certified RN’s • One Home Health RN • One Physical Therapist • Home Health Quality Manager • Home Health and Network Hospital Leadership

7. Our Plan… • Develop a comprehensive pressure ulcer prevention program that targets multiple factors that contribute to pressure ulcer formation • Develop script for clinicians to use with patients to explain importance of head to toe skin assessment • Devise a consistent process when instructing patients on measures to prevent pressure ulcers including use of a skin care product • Add prompts related to pressure ulcer prevention to OASIS to remind clinicians to educate patients at risk and to facilitate ease of documentation • Create resource tools containing pictures of pressure ulcers at various stages and guidance for OASIS M questions related to pressure ulcers • Educate staff through a train the trainer process based on clinician’s perceived need

8. Do… • Process • Patients with a Braden Score of 18 or less received a free prevention product • Purple cap for patients with “pretty” skin • Blue cap for patients in need of a “barrier” due to moist skin • Added check off boxes to OASIS to prompt clinicians to provide education patients at risk and to facilitate ease of documentation • Product • Provided patients with a tangible product and had staff “show and tell” about the product’s use lending credence to the importance of skin care

9. Do. . . • Pictures • Developed resource tools containing pictures of pressure ulcers at various stages and CMS guidance on answer pressure ulcer M questions on OASIS • People • Added teaching handout on pressure ulcer prevention to each admission packet • Evaluated staff’s perceived knowledge of pressure ulcer staging, prevention and product use as well as their ability to document OASIS C responses using a survey tool

10. Phase 3: CHECK

11. Phase 4: ACT • Develop and distribute body map containing location sites to promote consistent wound labeling • Develop and distribute wound product resource tool that describes product purpose and use for wounds of various etiologies including pressure ulcers

12. Questions…

13. VNA Mission The Visiting Nurse Association of St. Luke’s, as part of the St. Luke’s Hospital & Health Network, will provide compassionate, excellent quality, cost effective home health care, hospice services and home based parent/child programs. Vision The Visiting Nurse Association of St. Luke’s will be the Leader in Community Based Healthcare.