Kathy Borchert, RN, BA, Certified Wound, Ostomy and Continence Nurse
Jillyne Frazier, RN, MSN, System Director, Nursing Practice and Clinical Education
Judy Bakke, MBA, CPHQ, Performance Improvement Specialist
Maria Raines, APRN–BC, Medical Surgical Clinical Nurse Specialist
Sacha Kelly, APRN–BC, AOCN, Medical Surgical Clinical Nurse Specialist
Lucy Arntson, RN, CNP, Certified Wound and Ostomy Nurse

***Watch a video clip of HealthEast’s improvement work shared at IHI’s 19th Annual National Forum.***

To reduce to zero the incidence of Stage III and IV pressure ulcers developed during hospitalization by 2010.

The Pressure Ulcer Prevention Performance Improvement (PUPPI) task force developed a work plan outlining improvement actions modeled in part from the recommendations of the Minnesota Department of Health’s Safe Skin initiative. The task force identified individuals responsible to complete each action item and established target due dates.

We implemented the following action items:

• Articulated skin breakdown prevention as a nursing standard of practice
• Developed policies and procedures on managing skin integrity, pressure ulcer risk evaluation, skin inspection and wound assessment (adult medical/surgical and ICU, pediatrics)
• Developed an oral/enteral nutrition therapy protocol for adult patients with pressure ulcers
• Developed a Tissue Integrity Resource Manual containing skin management practice information for each nursing unit
• Completed implementation of pressure reduction mattresses at all sites
• Designated skin care champions at each site to model and promote best practices and assist in educating co-workers on practice changes
• Evaluated skin management documentation tools (electronic and paper) for completeness and incorporating revisions as needed
• Developed and implemented core knowledge requirements and a validation process for newly hired RNs, LPNs, and nursing assistants
• Developed and implemented core knowledge requirements and validation/annual update processes for registered dietitians
• Completed additional nursing education on skin management through internal and external mechanisms
• Implemented site-specific repositioning aids such as clocks
• Developed and distributed skin safety strategies information for unit staff
• Posted skin safety strategies information sheets for patients and families in patient rooms
• Increased pressure ulcer Prevalence and Incidence (P&I) monitoring to quarterly

There has been a decrease in the incidence of hospital-acquired and Stage III and IV pressure ulcers to zero in FY 2007 for our organization.

Keys to project success include:

• Active support of corporate and site senior leaders
• Engagement of site staff in the improvement process
• Designation of needed resources such as staff time to attend meetings and complete assignments
• Implementation of site-based skin champions

The continued work of this team is focused on:

• Evaluation and implementation of best practices for prevention of skin breakdown in the Emergency Department, Surgery, Maternity Care, and Behavioral Health areas
• Implementation of process improvements related to distribution and consumption of patient snacks and supplements, pressure ulcer prevention in the morbidly obese patient
• Ongoing practice evaluation, including use of NDNQI data, to ensure the delivery of high quality skin care

Judy Bakke, Performance Improvement Specialist
HealthEast Care System
jlbakke@healtheast.org

[Posterboard presentation from IHI's December 2007 National Forum]