When it comes to Hospital Acquired Pressure Ulcers (HAPUs), the San Jose Respiratory Care team employs a preventive approach: Conduct routine skin integrity assessments—four per patient during each 12-hour shift—and document observations in patient charts.
Still, the department had five reportable respiratory device-related pressure ulcers during the first six months of 2012.
Disturbed by this trend, team members decided to take a closer look at the process, engaging the entire department in the review, says co-lead Swapna Chimote, respiratory therapist and SEIU UHW member. They found that skin assessments were being done for some but not all of the devises and that observations weren’t always being charted.
“There was a lack of accountability,” says Lana Terry, team co-lead and department manager.
In May 2012 the team developed a SMART goal of maintaining a 90 percent completion rate of skin assessments for two consecutive quarters. To achieve that goal, the team tried the following small tests of change:
- Tracking respiratory device-related skin assessments electronically on a weekly basis
- Auditing assessments on a monthly basis and posting results beside the names of the corresponding respiratory therapists
- Providing counseling and encouragement for those who aren’t meeting the goal
Progress was slow at first—the June audit showed only 72 percent compliance—but it quickly picked up by a total of 26 percentage points by August. The team exceeded its goal in the third and fourth quarters.
“We post audit results by name, whether the individual met the goal or not,” says Terry. “This keeps staff accountable and lets me know if an individual needs counseling.”
No one objected to having their individual performance displayed publicly, says union co-lead Swapna Chimote, respiratory therapist and SEIU UHW member. “Everybody’s on board because everybody wants the same thing: to give the patients the best care possible."
As of January 2013 the department has had one reportable HAPU. This was caused by sutures being left in longer than the physician had order. Improved communication with nurses ensures that this type of HAPU won't reoccur, says Terry.
June 72 percent
July 88 percent
August 98 percent
3rd quarter results: 91 percent
4th quarter results 96 percent