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Improved Process Helps to Reduce Bed Sores

Deck: 
Team cuts incidence of pressure ulcers to 0

The medical/surgical staff at Fontana Medical Center had a problem with pressure ulcers. The 59-bed unit averaged about 10 of these hospital-acquired bed sores a quarter.

It's painful for the patient and costly for the hospital, which can average about $43,000 per incident. But pressure ulcers are also preventable, and that can lead to shorter hospital stays and improved patient satisfaction scores. Reducing the rate of pressure ulcers can also eliminate inquiries from the California Department of Health Services.

Based on recommendations from the UBT, the staff implemented an education program and provided one-on-one training on how to spot, rate and reduce bed sores.

The team established a strict regimen that included rating patients on the Braden Scale, which helps identify those at risk for pressure ulcers. They performed morning assessments, and used waffle mattresses and moisture-protective barriers for at-risk patients.

They also rounded hourly for turning and got patients out of bed three or four times a day to decrease their risks. This allowed patients to use the restroom and to keep them clean.

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

In a span of two years, the new process helped the team reduce the number of bed sores to 0.

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

Coming up with a new process to combat pressure ulcers helped the team build a sense of unity and staff satisfaction, but they also know the work continues.

“Sustaining our success is the biggest challenge because you can revert back to old practices,” Smith says. “You have to keep emphasizing what we’re doing and what the reasons are. Make sure they know you appreciate them so they continue to do well.”

Getting Home Health Care to the Patient On Time

Deck: 
UBT streamlines the intake process and works closely with referring departments

The Clinical Home Health Care team in San Diego needed to see discharged patients within 24 hours.

But they were hitting less than 50 percent success, and given their patients included those in hospice and palliative care, this was a problem.

At issue was a patient discharge list that might have 50 or more names. An intake nurse would dictate patient information to a department clerk, who would complete the forms. Only then would a home health visit get triggered.

This wasted time.

Modeled after a successful practice at Riverside Medical Center, the team did two things. First, they eliminated the clerk from the workflow and had the nurses process the patient information directly.

And second, they trimmed the list of names being referred to Home Health Care to only those patients who were getting discharged within the next 48 hours.

“We plan our day based on that list,” says Daniele Wilson, director of patient care services for home care. “But we cannot plan if that list is not updated. We needed to focus on the work that needed to be done more immediately.”

Home Health Care intake nurses also communicated with the discharge planners to get up-to-the-hour information on which patients will be released that day and need to be seen by a Home Health Care provider within the following 24 hours.

That group was reduced to about five daily patients, and in two months the number of referrals seen within 24 hours grew from 44 to 77 percent.

“It’s much easier to tackle when a list has a handful of names,” Wilson says. “When it was 50-some it was difficult to even know where to begin. It felt futile.”

The team included daily morning huddles to review the number of newly referred patients and their needs, as well as ongoing patient needs. They also improved communication with the referring departments, such as orthopedics and primary care.

“We reached out to different heads of departments to figure out how they operated,” Wilson says. “By understanding how they operated, it helped us know how we can interact with them.”

Lisa Tuckwell, RN, public health nurse and UNAC/UCHP member, learned to speak doc.

“We figured out the buzz words that got a doctor to act.”

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