April 19, 2014

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Preventing Pressure Ulcers Is a Team Effort

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.

Audit results:

June 72 percent

July 88 percent

August 98 percent

3rd quarter results: 91 percent

4th quarter results 96 percent

 

 

Getting to Zero Pressure Ulcers

GOT QUESTIONS? GET ANSWERS
Use this contact information to find out more.
Management co-lead(s)

Lana Terry, ,lana.terry@kp.org

Union co-lead(s)

Swapna Chimote, swapna.s.chimote@kp.org

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Patient Safety

Department: Respiratory Care, San Jose Medical Center

SMART goal: Sustain a 90 percent completion rate of skin integrity assessments for susceptible endotracheal tube patients for two consecutive quarters in 2012.

Problem: The department had five reportable Hospital Acquired Pressure Ulcers (HAPUs) in the first six months of 2012 despite routine skin assessments.

Value Compass: Quality

Metric: HAPU Management Report

Union co-lead: Swapna Chimote, respiratory care therapist and SEIU UHW member

Management co-lead: Lana Terry, respiratory care manager

Small test of change: Track and audit skin assessments and post-performance results with name of responsible respiratory therapist.

Result: As of January 2013 the department has had one reportable HAPU.

Biggest challenge: Ensuring that nurses remove sutures from tube insertion procedure according to the physician's order to prevent potential HAPU.

Advice to other teams: Communicate expectations clearly and educate staff to ensure observations are documented properly in patient charts.

Background

Disturbed by the five HAPU cases in the first half of the year despite the systems in place to prevent them, team members decided to look for what might be going wrong.

Starting in May 2012, the team tried the following small tests of change:

  • Tracking all respiratory device-related skin assessments electronically on a weekly basis
  • Auditing assessments on a monthly basis and posting results with names of respiratory therapists
  • Provide counseling and encouragement for those who don’t meet goal

The June audit showed only 72 percent compliance—but it quickly picked up by a total of 26 percentage points in August. The goal was exceeded in the third and fourth quarters, and as of January 2013 the department has had one reportable pressure ulcer, due to sutures being left in longer than the physician had ordered.

Read the full story.