Pressure ulcer awareness and prevention programs at hospitals have come into focus since the Centers for Medicare and Medicaid Services announced in 2007 that Medicare no longer would pay for never events. The news that in 2008 hospitals would have to shoulder costs for such events as stage 3 or 4 pressure ulcers acquired after admission sent facilities scrambling, said Barbara Delmore, RN, PhD, CWCN, AAPWCA, clinical nurse specialist at NYU Langone Medical Center in New York City.
Prior to never events, staff members worked in silos to address and prevent pressure ulcers, and it since has been a daunting task to get everyone who cares for and interacts with patients on the same page, Delmore says.
“Pressure ulcer prevention is just not one person’s job,” she says. “It’s the whole team coming together 24/7 to make pressure ulcer prevention programs a success.”
NYU developed a strategy to address pressure ulcers by creating a prevention model based on an eight-spoke wheel. The eight spokes are assessment, including skin and risk assessment; skin care; reducing risk factors; nutrition/hydration assessment and intervention; pressure redistribution surfaces; patient/family education; clinician training; and protocols/procedures.
“Once you get this program in place, you don’t want it to fall apart,” Delmore says. “There’s research out there that shows us that ... when the spokes on the wheel all come together they work. When they don’t ... your [pressure ulcer] incidence, which may have been declining, will rise again.”
NYU Langone Medical Center has dramatically reduced pressure ulcer incidence, from about 7.3% two and half years ago to 2.5% today, Delmore said.
She explains that nearly every hospital staff member has some stake in pressure ulcer prevention, including dietitians; physical and occupational therapists; physicians; all levels of nursing, including patient care technicians, nursing staff, nurse practitioners and leadership; logistics and purchasing managers; and building services and facilities staff.
“We can’t do it without them is the bottom line,” Delmore says.
Prior to never events, staff members worked in silos to address and prevent pressure ulcers, and it since has been a daunting task to get everyone who cares for and interacts with patients on the same page, Delmore says.
“Pressure ulcer prevention is just not one person’s job,” she says. “It’s the whole team coming together 24/7 to make pressure ulcer prevention programs a success.”
NYU developed a strategy to address pressure ulcers by creating a prevention model based on an eight-spoke wheel. The eight spokes are assessment, including skin and risk assessment; skin care; reducing risk factors; nutrition/hydration assessment and intervention; pressure redistribution surfaces; patient/family education; clinician training; and protocols/procedures.
“Once you get this program in place, you don’t want it to fall apart,” Delmore says. “There’s research out there that shows us that ... when the spokes on the wheel all come together they work. When they don’t ... your [pressure ulcer] incidence, which may have been declining, will rise again.”
NYU Langone Medical Center has dramatically reduced pressure ulcer incidence, from about 7.3% two and half years ago to 2.5% today, Delmore said.
She explains that nearly every hospital staff member has some stake in pressure ulcer prevention, including dietitians; physical and occupational therapists; physicians; all levels of nursing, including patient care technicians, nursing staff, nurse practitioners and leadership; logistics and purchasing managers; and building services and facilities staff.
“We can’t do it without them is the bottom line,” Delmore says.
Empowering the Front Line
Donna Kozub, RN-BC, clinical education coordinator at JFK Medical Center in Edison, N.J., created and teaches the Be a Skin Detective: Recognize, Report, Prevent program based on her observation that communication between nurses and patient care technicians was impeding pressure ulcer prevention.
Kozub teaches the now-mandatory course for JFK Medical Center’s PCTs by educating them about staging and other aspects of pressure ulcers traditionally taught only to nurses. She covers the importance of clear and direct communication. Part of the coursework is in the classroom and the rest involves asking a unit nurse to go to the bedside of a patient at risk for pressure ulcers. The nurse and PCT review prevention and discuss the patient.
“The whole goal was getting them to feel very comfortable in talking to the RN,” Kozub says.
Christine Holder, a PCT at JFK Medical Center, says the program opened her eyes and empowered her to speak up about pressure ulcers. “If we see something that’s not the norm on anybody, it’s important to go and get the nurse as soon as possible, instead of waiting until later because we’re so busy throughout the day that we might forget,” Holder says.
Donna Kozub, RN-BC, clinical education coordinator at JFK Medical Center in Edison, N.J., created and teaches the Be a Skin Detective: Recognize, Report, Prevent program based on her observation that communication between nurses and patient care technicians was impeding pressure ulcer prevention.
Kozub teaches the now-mandatory course for JFK Medical Center’s PCTs by educating them about staging and other aspects of pressure ulcers traditionally taught only to nurses. She covers the importance of clear and direct communication. Part of the coursework is in the classroom and the rest involves asking a unit nurse to go to the bedside of a patient at risk for pressure ulcers. The nurse and PCT review prevention and discuss the patient.
“The whole goal was getting them to feel very comfortable in talking to the RN,” Kozub says.
Christine Holder, a PCT at JFK Medical Center, says the program opened her eyes and empowered her to speak up about pressure ulcers. “If we see something that’s not the norm on anybody, it’s important to go and get the nurse as soon as possible, instead of waiting until later because we’re so busy throughout the day that we might forget,” Holder says.
Taking the Time
Peggy Petrucelli, RN, BSN, coordinator of wounds and falls at Jersey City (N.J.) Medical Center, used to view pressure ulcer prevalence monitoring as a task. Now, it’s her passion to look at the numbers in terms of outcomes.
She says in 2009 the hospital reported 24 pressure ulcers: eight in the first quarter, and six, six and four in the ensuing quarters. By 2010, a renewed focus on pressure ulcers led to a dramatic reduction: one in the first quarter, two in the second and zero in the third.
Collaborative programs with not only hospital staff but also local nursing homes, home care and other hospitals helps to drive innovation and solutions, she says.
One of the hurdles to implementation, Petrucelli says, is time management. “To take the time to say, ‘I’m discharging Mary Jones today. Let’s give that nursing home a quick call and talk to the wound care person there and say these were my challenges,’” she says. “It’s the details that you can’t always communicate on the discharge [papers].”
Peggy Petrucelli, RN, BSN, coordinator of wounds and falls at Jersey City (N.J.) Medical Center, used to view pressure ulcer prevalence monitoring as a task. Now, it’s her passion to look at the numbers in terms of outcomes.
She says in 2009 the hospital reported 24 pressure ulcers: eight in the first quarter, and six, six and four in the ensuing quarters. By 2010, a renewed focus on pressure ulcers led to a dramatic reduction: one in the first quarter, two in the second and zero in the third.
Collaborative programs with not only hospital staff but also local nursing homes, home care and other hospitals helps to drive innovation and solutions, she says.
One of the hurdles to implementation, Petrucelli says, is time management. “To take the time to say, ‘I’m discharging Mary Jones today. Let’s give that nursing home a quick call and talk to the wound care person there and say these were my challenges,’” she says. “It’s the details that you can’t always communicate on the discharge [papers].”
Education and Collaboration
Marie Torell-Alverio, RN, MSN, CNS, WCC, clinical supervisor of wound care at Coney Island Hospital in Brooklyn, N.Y., says one of the biggest hurdles many hospitals face is inaccurate assessments of the ulcers.
She solved that problem by implementing digital imaging technology, which took the place of Polaroid pictures and hand-written chart descriptions. The technology gives specifications for capturing wounds digitally, then helps the operator accurately evaluate the wound.
“Since implementing this technology, we went from nurses and physicians documenting with 50% inaccuracy ... to, now, 100% accuracy,” Torell-Alverio says.
She and her staff have been collaborating with hospitals and nursing homes to decrease healthcare facility-acquired pressure ulcers. “I was getting in horrible cases [of pressure ulcers],” Torell-Alverio says. “I would see which nursing homes these were coming from and reached out to them.”
She continues to meet with nursing home staff to educate them about pressure ulcer prevention and open lines of communication between hospital and nursing home staff.
“If I’m treating a patient a certain way, and I communicate that with the nursing home that’s going to receive that patient, and they continue with that care, we share wonderful success stories,” Torell-Alverio says. “The same is true vice versa.”
Collectively, the programs resulted in a 60% reduction of pressure ulcers at Coney Island Hospital and a 25% reduction in the number of people arriving at Coney Island Hospital with pressure ulcers from local collaborating nursing homes, according to Torell-Alverio.
Having more direct communication with Coney Island Hospital is a move in the right direction for Shorefront Center for Rehabilitation and Nursing Care in Brooklyn, said Jessica Wares, RN-BC, Shorefront’s director of nursing.
“If we’re unsure of what treatment has been tried at the hospital or if we have a difficult case, we can collaborate with them to see what they have already tried, what worked and what didn’t work, and how to move forward,” Wares says.
Marcela Vasko, RN, assistant head nurse and wound care team member at Coney Island, says communication among medical staff members within and outside the hospital is important for continuity of care. “At the end of the day, we know exactly about every patient — about all the wounds,” Vasko says. “We communicate; we talk to each other. ... I believe that is the way it should be.”
Marie Torell-Alverio, RN, MSN, CNS, WCC, clinical supervisor of wound care at Coney Island Hospital in Brooklyn, N.Y., says one of the biggest hurdles many hospitals face is inaccurate assessments of the ulcers.
She solved that problem by implementing digital imaging technology, which took the place of Polaroid pictures and hand-written chart descriptions. The technology gives specifications for capturing wounds digitally, then helps the operator accurately evaluate the wound.
“Since implementing this technology, we went from nurses and physicians documenting with 50% inaccuracy ... to, now, 100% accuracy,” Torell-Alverio says.
She and her staff have been collaborating with hospitals and nursing homes to decrease healthcare facility-acquired pressure ulcers. “I was getting in horrible cases [of pressure ulcers],” Torell-Alverio says. “I would see which nursing homes these were coming from and reached out to them.”
She continues to meet with nursing home staff to educate them about pressure ulcer prevention and open lines of communication between hospital and nursing home staff.
“If I’m treating a patient a certain way, and I communicate that with the nursing home that’s going to receive that patient, and they continue with that care, we share wonderful success stories,” Torell-Alverio says. “The same is true vice versa.”
Collectively, the programs resulted in a 60% reduction of pressure ulcers at Coney Island Hospital and a 25% reduction in the number of people arriving at Coney Island Hospital with pressure ulcers from local collaborating nursing homes, according to Torell-Alverio.
Having more direct communication with Coney Island Hospital is a move in the right direction for Shorefront Center for Rehabilitation and Nursing Care in Brooklyn, said Jessica Wares, RN-BC, Shorefront’s director of nursing.
“If we’re unsure of what treatment has been tried at the hospital or if we have a difficult case, we can collaborate with them to see what they have already tried, what worked and what didn’t work, and how to move forward,” Wares says.
Marcela Vasko, RN, assistant head nurse and wound care team member at Coney Island, says communication among medical staff members within and outside the hospital is important for continuity of care. “At the end of the day, we know exactly about every patient — about all the wounds,” Vasko says. “We communicate; we talk to each other. ... I believe that is the way it should be.”
Lisette Hilton is a freelance writer. Send letters to editorNY@nursingspectrum.com or comment below.