Intermountain-led CMS Hospital Engagement Network

Preventing Pressure UlcersOctober 22, 2013 Affinity Call

• Marlyn Conti - Intermountain, Patient Safety Coordinator• Gina Honermann-Garinger—Baylor Scott & White Health,

Center for Clinical Innovation

Outline for Discussion

• HEN Pressure ulcer data• What have you implemented this past year?• What are your challenges? • What’s next for your facility/system?

Intermountain HEN 2012-13 submitting Hospitals

Braden Risk AssessmentIntermountain HEN

Rate going up. Braden & Skin Assessment required within 24 Hours of admit

Ulcers below national best practice benchmark and trending down

Is this coding artifact? Are we charting better?

Intermountain HEN PrU =>3

HEN Pressure Ulcer Measures

• Metric specification resource manual http://www.henlearner.org/wp-content/uploads/2012/03/HEN_measure_Feb5.pdf

• Submission schedule: – November 20, 2013: for data through September 2013

Intermountain PrU Prevalence Trends

All stages per quarterly prevalence survey, 22 hospitals

2004

.1 Q3

2005

.1 Q3

2006

.1 Q3

2007

.1 Q3

2008

.1 Q3

2009

.1 Q3

2012

Q1 Q3

2011

Q1 Q3

2012

Q1 Q3

2013

Q1 Q30

2

4

6

8

10

12

14

12.8

8.38.8

9.8

7.8

10.3

7.97.4

10.3

6.7 6.8

4.5

6.8

4.6

1.6

3.5 3.64.0

3.23.9

3.43.1

2.32.7 2.6 2.5

2.9

2.02.4 2.4

1.82.4

2.72.0 2.1 2.2 2.4

1.5 1.5

Intermountain Pressure Ulcer Prevalence Rate per 100 Pa-tients Surveyed 2004-2013

Hospital AcquiredLinear (Hospital Acquired)

Mattress purchase

Mattress Inspec-tions

Ulcer Teams

Required education

Intermountain Hospitals

Intermountain Hospitals

Intermountain Hospitals

Call drill down to the patient and do cause analysis

Intermountain HospitalsPressure Ulcer Prevention Tools

• Care plan for kardex• Bed & surface

algorithm• Skin care product

posters• Patient fact sheets

Working Harder

Baylor All Saints Hospital Acquired Pressure Ulcers

PUT new data here pleaseJanuary

2013February

2013March 2013

4 0 0155 162 0

0.0258065 0 0

Baylor All SaintsPressure Ulcers > Stage 3

2013 Q1 & June Comparison Run ChartJanuary 2012 February

2013March 2013

1 0 0155 162 0

0.0064516 0 0

Baylor All SaintsAHRQ PSI #3

2013 Q1 & June Comparison Run ChartJanuary

2013February

2013March 2013

0 0 0365 288 298

0 0 0

Participant Poll

What to dofor:

Getting Started

Working Harder

Ahead of the Curve

Pressure Injuries

Identify areas needing most attention & appoint a leadership supported “lead” to drive improvement & education SWAT (or champion) teams that includes unit nurse/

Adopt decision algorithms for RNs to select appropriate surfaces make decisions independently of surface decisions.

Establish monthly prevalence studies or incidence rates from electronic medical records then feed that data back to the SWAT teams.

System

What have you implemented

What are your challenges

What’s next

Intermountain

Pressure ulcer bundlesHard coding interventions in computer charting based on Braden scores

‘Getting to Zero’ComplacencyKnown complicationCompeting priorities

Bundle compliance tracking

Baylor

Policy & procedures to back-up protocolBedside reporting

Present on admission reporting is improving

EHR support for risk assessment Documentation of present on admission

Participants

Trial of iPad app for picture documentation in EHR

19

Pressure Ulcer Elimination“Bundle” = SKIN (Ascension Health)

Tissue injury can be more than skin deep…

SKIN Manage Nutrition and

Hydration

Manage Incontinence

Keep Patients Moving

Selection of Appropriate Support Surfaces

Getting StartedAccess Available Tool Kits

• Preventing Pressure Ulcers in

Hospitals: A Toolkit for Improving Quality of Care http://www.ahrq.gov/research/ltc/pressureulcertoolkit/

• National Pressure Ulcer Advisory Panel http://www.npuap.org/

• http://www.Henlearner.org

• AHRQ PSNet http://www.psnet.ahrq.gov/

• AHRQ Web M&M http://www.webmm.ahrq.gov/

• AHRQ Health Care Innovations Exchange http://www.innovations.ahrq.gov/

Getting Started

Next Affinity Call Pending

• What questions or topics would you like addressed?

• Send questions to Admin@HenLearner.org• Access HEN webinars and resources at

http://www.henlearner.org/