Biggest challenge:

“Sustaining our success is the biggest challenge because you can revert back to old practices,” said management co-lead Smith. “You have to keep emphasizing what we’re doing and what the reasons are…. Keep the staff motivated and aware of their outcomes and how they’re doing. Make them feel good about it. Make sure they know you appreciate them so they continue to do well.”

Advice to other teams:

“The UBT helps our collaboration,” said charge nurse Toni Leonen, the UBT’s union co-lead. “We disseminate information to staff through our meetings and newsletters. Once we identify the patients, the RNs monitor the turning of the patients. It’s an effort that each of the UBT members try to accomplish. With HealthConnect, it’s quite easy, too. We put in for a nutrition consult. And we get their support.”

Side benefits:

After six consecutive quarters without a pressure ulcer among their patients, the nearly 100 staff members of the Fontana Medical Center med/surg unit are proud, says management co-lead Kathy Smith. Deservedly so.

Since they organized a unit-based team during the first wave of UBT launches in 2007, they have collaborated with wound-certified nurses and nutritionists, adopted vigilance and a strict regimen to eliminate ulcers and in the process increased a sense of unity, staff satisfaction and morale.

Bottom line:

Eliminating pressure ulcers has reduced pain and discomfort for the team’s patients. It also translates to shorter hospital stays, lower costs (pressure ulcers cost an average of $43,000 per incident) and improved patient satisfaction scores. It has also eliminated inquiries from the California Department of Health Services, which looks into incidents of pressure ulcers.

Background:

The staff of the 59-bed med/surg unit at Fontana Medical Center includes RNs, managers, a unit secretary and PCAs. In 2006, Smith estimates the unit had about 10 hospital-acquired pressure ulcers. By implementing an education program and providing one-on-one training with staff, that number came down to seven in 2007, about the time the unit-based team was started. Based on recommendations from the UBT, staff members established a strict regimen that included rating patients on the Braden Scale, which helps identify those at risk for pressure ulcers, performing morning assessment rounds, using moisture-protective barriers for patients at risk, and hourly rounding for turning, restroom use and getting patients up out of bed three or four times a day to decrease their risks.

By the first quarter of 2008, the team had reduced ulcers to two. By the end of September 2009, there had been no bed sores for six consecutive quarters—vaulting their approach into the realm of “best practice.” The co-leads are scheduled to present at the region’s fifth annual quality and innovation conference in Anaheim in October.

“It’s pretty much a collaborative effort among nurses, nutritionists and wound specialists,” says Leonen. “The nurses are receptive to implementing the various methods we use to prevent pressure ulcers.”

“We’ve created this environment where the staff thinks safety and thinks patient comfort,” Smith says. “It’s automatic. They just come in and make sure patients are turned. Nobody has to remind them.”