Location
Virtual
Start Date
1-3-2024 8:00 AM
End Date
1-3-2024 3:30 PM
Keywords:
oregon
Description
Background:
Pressure ulcers (PU) are a "localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or shear/friction". PU are an urgent problem in the United States (U.S.). Residents in skilled nursing facilities (SNF) are disproportionately affected, with 9.2% of residents estimated to suffer a PU nationally. The Braden Scale is gold standard for identifying individuals at risk for PU in healthcare settings across the continuum and grades PU risk in 6 categories: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. To protect against PU, a Braden Scale must be documented on admission to a healthcare facility and at regular intervals. Then, for individuals scored at-risk for PU within Braden Scale subcategories, an interdisciplinary care plan including targeted interventions is required. At a 94-bed rural SNF, Braden Scores were frequently not documented per policy, nor were interventions developed/implemented by the interdisciplinary team via Braden subcategory scores.
Aim:
To test effectiveness of education on gold standard PU assessment and care plan development/implementation on reducing PU incidence.
Methods/Approach:
This 8-week quality improvement project, conducted Fall 2022, first provided best practice education to staff at the SNF on documenting the Braden Scale per policy (first process measure), and how to interpret subcategory scores to inform targeted PU prevention strategies. Then, for residents assessed as high-risk for PU, an interdisciplinary team meeting (IDT) was required to take place within 48 hours to create an individualized, Braden subcategory score-informed care plan (second process measure). Finally, targeted interventions were required to be implemented within 72 hours of high-risk PU screening (third process measure). Proof of IDT were documented in a spreadsheet accessible to all stakeholders. Review of charts and spreadsheets determined whether the three process measures were conducted per new policy. PU prevalence data were obtained through a national reporting database and descriptively compared 8 weeks before to 8 weeks after education. Compliance with process measures were calculated descriptively and proportion of residents with three measures completed per policy versus not were compared via chi-square.
Results:
The following compliance rates were noted across 21 residents who met criteria for at-risk PU during the project period: 90.5% of Braden Scores completed, 85.7% of IDT occurred, and 85.7% of interventions implemented. PU reduced from 25.7% to 20.0%. No significant differences emerged between proportion of process measures that were completed per policy versus not (p>0.05).
Conclusion:
We report high compliance with new skin policy and reduction in PU in our SNF. No differences were noted between process measures by compliance rates, suggesting staff completed all three equally across eligible residents.
Implications for practice:
Ensuring timely Braden scores are documented, a resultant interdisciplinary care plan is created, and targeted interventions are implemented can reduce PU in the SNF setting. Nurses working in any setting could benefit from using subcategory scores in partnership with the interdisciplinary team to inform best skin protection interventions.
Recommended Citation
Mattsson, Shaune, "A Quality Improvement Project to Decrease New or Worsening Pressure Ulcers in a Skilled Nursing Facility (D-PUS SNF)" (2024). Providence Nursing Research Conference 2023 – Present. 2.
https://digitalcommons.providence.org/prov_rn_conf_annual/2024/posters/2
Department
Quality
Department
Nursing
Included in
A Quality Improvement Project to Decrease New or Worsening Pressure Ulcers in a Skilled Nursing Facility (D-PUS SNF)
Virtual
Background:
Pressure ulcers (PU) are a "localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or shear/friction". PU are an urgent problem in the United States (U.S.). Residents in skilled nursing facilities (SNF) are disproportionately affected, with 9.2% of residents estimated to suffer a PU nationally. The Braden Scale is gold standard for identifying individuals at risk for PU in healthcare settings across the continuum and grades PU risk in 6 categories: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. To protect against PU, a Braden Scale must be documented on admission to a healthcare facility and at regular intervals. Then, for individuals scored at-risk for PU within Braden Scale subcategories, an interdisciplinary care plan including targeted interventions is required. At a 94-bed rural SNF, Braden Scores were frequently not documented per policy, nor were interventions developed/implemented by the interdisciplinary team via Braden subcategory scores.
Aim:
To test effectiveness of education on gold standard PU assessment and care plan development/implementation on reducing PU incidence.
Methods/Approach:
This 8-week quality improvement project, conducted Fall 2022, first provided best practice education to staff at the SNF on documenting the Braden Scale per policy (first process measure), and how to interpret subcategory scores to inform targeted PU prevention strategies. Then, for residents assessed as high-risk for PU, an interdisciplinary team meeting (IDT) was required to take place within 48 hours to create an individualized, Braden subcategory score-informed care plan (second process measure). Finally, targeted interventions were required to be implemented within 72 hours of high-risk PU screening (third process measure). Proof of IDT were documented in a spreadsheet accessible to all stakeholders. Review of charts and spreadsheets determined whether the three process measures were conducted per new policy. PU prevalence data were obtained through a national reporting database and descriptively compared 8 weeks before to 8 weeks after education. Compliance with process measures were calculated descriptively and proportion of residents with three measures completed per policy versus not were compared via chi-square.
Results:
The following compliance rates were noted across 21 residents who met criteria for at-risk PU during the project period: 90.5% of Braden Scores completed, 85.7% of IDT occurred, and 85.7% of interventions implemented. PU reduced from 25.7% to 20.0%. No significant differences emerged between proportion of process measures that were completed per policy versus not (p>0.05).
Conclusion:
We report high compliance with new skin policy and reduction in PU in our SNF. No differences were noted between process measures by compliance rates, suggesting staff completed all three equally across eligible residents.
Implications for practice:
Ensuring timely Braden scores are documented, a resultant interdisciplinary care plan is created, and targeted interventions are implemented can reduce PU in the SNF setting. Nurses working in any setting could benefit from using subcategory scores in partnership with the interdisciplinary team to inform best skin protection interventions.
