UPMC St. Margaret’s Hospital DNP...UPMC St. Margaret’s Hospital Preventing Falls and Pressure...
Transcript of UPMC St. Margaret’s Hospital DNP...UPMC St. Margaret’s Hospital Preventing Falls and Pressure...
UPMC St. Margaret’s Hospital
Preventing Falls and Pressure
Ulcers: A Strategic Plan
Presented By
DNP Consultant Team
Sunday, July 29, 2012
Waynesburg Monroeville Cohort
Margaret A. Boyce, MSN, MBA, RN
Karen G. Chambers, MSN, CGRN, RN
Janet Kovatch-Janovsky, MSN, RN
Melissa L. Mastorovich, MSN, BC, RN
Melissa L. Rudd, MSN, CRNP
UPMC St. Margaret’s
Demographics
Established late 1800’s
Magnet status
249 Bed acute care and teaching
community hospital
Serves 250,000 residents of
Allegheny County
St. Margaret’s Mission Statement
To provide premier programs
in patient care, biomedical and
health services research, and
teaching that contributes to
the prevention, diagnosis, and
treatment of human disease
and disability.
SMH Leadership
Team Proposal
Create an inter professional approach to
recognition, evaluation and prevention of
patient falls & facility acquired
pressure ulcers in an acute care hospital
Strengths Current administrative teams
QI teams
Engaged staff
Two ET nurses
Staff mix
Weaknesses Limited resource staff
Inconsistent safety measures
Turning regimen
Ulcer staging
Bedside report
Obstacles Lack of “buy in”
Budget constraints
Sustainability
Threats Decreased reimbursement
Decreased patient satisfaction
Personnel recruitment and retention
SWOT
National Fall Statistics
Most common cause of injuries and
hospital admissions among the
elderly (Moyer,2011)
The second leading cause of injury –
related deaths for people ages 65 and
older (Moyer,2011)
By 2020 fall costs will exceed $30
billion (Chang et al., 2004; Ulrich& Zimring,2004)
SMH Fall Statistics
60% Falls occur
in pts A & O X 3
and > 60 years
RCA = No
Correlation
Goal 288/year
230
240
250
260
270
280
290
300
FALL PREVALENCE
FY 2010
FY 2011
FY 2012
255
pts
292
pts
252
pts
SMH FALL PREVALENCE
Survey Monkey Results
22.1%
15.9%
18.2%
42.9%
RN Years of Service
< 2 years
3-5 years
6-14 years
> 15 year
62% 15%
24%
.
FREQUENCY FOR FALL ASSESSMENT
QSHIFT Q 4 HRS Q 1 HR
HOW OFTEN DO YOU
ASSESS FOR FALLS?
Very familiar
67%
Somewhat
familiar 32%
Not at all
1% .
HOW FAMILIAR ARE YOU WITH
THE CURRENT FALL POLICY?
5.5%
57.5%
37.0%
Fall Prevention and Patient/Family Teaching
On admissiononly
q shift
As the situationarises
HOW OFTEN DO YOU PROVIDE PATIENT FAMILY TEACHING REGARDING FALL PREVENTION?
SMH Leadership
Team Proposal
Create an inter professional approach to
recognition, evaluation and prevention of
facility acquired skin ulcers in an
acute care hospital.
National Skin Ulcer Statistics
2.5 million patients treated yearly for
hospital acquired pressure ulcers
(HAPU);
Expenditures total $11 billion yearly;
HAPU is 5% in acute care;
Results in increased length of
stay by 9 days (Ayello,2011)
SMH Skin Statistics
162 HAPU (1%)
77 (48%) Patients Were Stage 2
Ulcers
Majority Were ICU Patients
RCA = No Correlation among
variables
8.1% on adm.
75.7% q shift
13.5%
q 4 hr
2.7%
q 1 hr
HOW FREQUENTLY DO YOU ASSESS HEAD TO
TOE SKIN INTEGRITY?
54.1% 40.5%
5.4%
HOW FAMILIAR ARE YOU WITH THE
SKIN CARE POLICY?
Very familiar
Somewhatfamiliar
Not at all
4.0%
Q shift
44.0%
2.7%
HOW OFTEN DO YOU EDUCATE YOUR PATIENTS
AND FAMILIES ABOUT PRESSURE ULCERS?
On admission only
Q shift
As the situation arises(prn)
Only the high riskpatients
49.3%
AS THE
SITUATION
ARISES
Evidence Based
Practice Findings
Communication
Bedside Report
Hourly Rounding
Enhance Patient-Centered Care
Education
Fall & Skin Unit Champions
HOURLY COMFORT ROUNDING
5- P’s (Potty, Pain, Position, Pumps,
Personal)(Halm, 2009; Bonuel, 2011; Studer et al., 2010)
Ringtones
Variable Rounder
Interdisciplinary Team
Recommendations
Enhanced Patient-Centered Care (McCane, McCormack, Dewing, 2011)
Quality & Patient Safety Brochure (www.njha.com)
Education
Recommendations
Journal club
Fall February
Skin September
Orientation
Annual Competencies
& Skills Fair
Newsletter-E