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Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.
Collaborative Governance Magnet Recognition Regulatory Readiness Innovation Units

Other Topics: Anticoagulation | CAUTI | Central Lines | Diversity | Downtime (internal access only)

Ethics | Evidence-Based Practice | Fall Prevention | Pain | Patient Education/Health Literacy | Patient Experience
Practice Alerts & Updates (internal access only) | Pressure Injuries | Process Improvement | Professional Development | Restraints | EED Home

Epic Documentation | Epic Communication

(internal access only)

A focus on pressure injuries —preventing the most frequent and
costliest SOS logohospital-acquired condition

  • Pressure ulcers affect 3 million adults in the United States. Medical conditions that increase the risk of developing pressure ulcers and slow ulcer healing relate to patient mobility (spinal cord injury), wound environment (incontinence), and wound healing (diabetes, vascular disease.)
  • Consequences of delayed healing can include prolonged hospitalization, failure to return to full functioning, and requirement of long-term care.
    The cost of treating a pressure ulcer can range from $37,000 to $70,000 per ulcer.
  • Total annual cost of treating pressure ulcers in the United States has been as high as $11 billion.

Pressure Ulcer Survey Results (internal access only)

Therapeutic, Bariatric and Safety Support Surface Algorithm (internal access only)

 

MASS GENERAL
"I Can Lift You Up"

CLICK HERE to watch our video

AN MGH NARRATIVE

M. M. is a 60 year old white male with paraplegia following a spinal cord injury (SCI) at thoracic spine 6 (T6) during a motor vehicle accident about five years ago. Following the SCI, he has required a wheelchair for mobility. He reports that he has his own wheelchair with a foam cushion that he sits in for many hours each day..  more...

Elzbieta Gilbride, RN, staff nurse, White 10, General Medicine

ALSO: Prior narrative by Heather Szymczak, RN, staff nurse, Internal Medical Associates, Urgent Care Clinic, previously a staff nurse on Ellison 22, Surgical...

THE DATA

All Hospital-Acquired Pressure Ulcer Prevalence (adult units)
(point prevalence = % of patients)

CLICK HERE for additional data

ALL STAGES
STAGES II or GREATER
TREND: All Stages: Favorable. 4 of 7 unit types outperform the NDNQI comparative benchmarks for the most recent quarter. Psychiatry does not have comparative NDNQI benchmarks but it has consistently maintained a rate of 0.
TREND: Stage II or Greater: Favorable. 5 of 7 unit types outperform the NDNQI comparative benchmarks for the most recent quarter. Psychiatry does not have comparative NDNQI benchmarks but it has consistently maintained a rate of 0.

 

 

 

Jan. - Mar. 2017
MGH  NDNQI
9.57% 7.14%
0.00% 3.33%
0.00% 0.32%
2.92% 1.69%
0.00% 1.67%
0.00% 0.53%
0.00% n/a
1.60% 1.23%
Jan. - Mar. 2017
MGH  NDNQI
6.38% 6.14%
0.00% 2.77%
0.00% 0.26%
2.34% 1.38%
0.00% 1.37%
0.00% 0.40%
0.00% n/a
0.00% 0.96%

NDNQI Benchmark: hospitals with 500+ beds; Green = Favorable, Red = Unfavorable


Save Our Skin logoPreventing hospital-acquired pressure ulcers (HAPU) is a top priority for healthcare organizations across the country. At MGH, the Clinical Nurse Specialist (CNS) Group and, in particular, the CNS Wound Care Task Force, as well as Professional Development Specialists from the Norman Knight Nursing Center for Clinical and Professional Development educate staff throughout the hospital about best practices related to preventing HAPU. Several years ago, the “Save Our SKIN” (SOS) program was introduced. The program deputizes all staff as SKIN Savers and employs the SKIN Bundle as a framework for safe SKIN practices. During the past year, the overall quarterly pressure ulcer prevalence rate has remained at a consistently low rate of 1.1% to 1.9%.

SOS Toolkit

Policies, Procedures & Guidelines:
(internal access only)

Wound Care Product Formulary

Nursing Practice Guideline For Skin and Wound Care

Quality & Safety Committee:
Meets: 4th Tuesday monthly
1:00pm-3:00pm
Sweet Room, GRB 432

IN THE NEWS
PRESSURE ULCER RESOURCES

MGH Resources

Risk assessment tool:  Braden Scale

Pressure ulcer staging:
National Dataset of Nursing Quality Indicators (NDNQI) Online Education Program

HealthStream Offerings
(internal access only)

Did You Know Posters

MGH Contacts:

External Resources

Agency for Healthcare Research and Quality (AHRQ)
The mission of AHRQ is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.

AHRQ Comparative Effectiveness Reviews
"Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness (May, 2013)

American Board of Wound Management (AAWM)
A national inter-disciplinary certifying board for healthcare professionals involved in wound care.

American College of Certified Wound Specialists (ACCWS)
Comprised of interdisciplinary wound care professionals who are certified as Certified Wound Specialists® (CWS®). The ACCWS provides education, informational resources and research avenues to enhance the knowledge, skills, professional performance and relationships required by health professionals to serve their patients, public, and professions.

Association for the Advancement of Wound Care (AAWC)
A multidisciplinary organization that spreads awareness about advanced, evidence based wound care by promoting excellence in education, clinical practice, public policy, and research. (Membership required.) AAWC Pressure Ulcer Guidelines (2016)

MedlinePlus
(National Library of Medicine and the National
Institutes of Health):
A comprehensive directory that links to different educational resources from reputable organizations on a variety of health topics.

National Pressure Ulcer Advisory Panel (NPUAP)
An independent not-for-profit professional organization dedicated to the prevention and management of pressure ulcers.

World Union of Wound Healing Societies (WUWHS)
The mission of the WUWHS is to enhance the life of persons with wounds worldwide.

Wound Healing Society
Composed of clinical and basic scientists and wound care specialists, the mission of the WHS is to improve wound healing outcomes through science, professional education, and communication.

Wound Ostomy Continence Nursing (WOCN)
A professional nursing society that supports its members by promoting educational, clinical, and research opportunities to advance the practice and guide the delivery of expert health care to individuals with wounds, ostomies, and incontinence. (Membership required.) WOCN Pressure Ulcer Guidelines (2016)

EXTERNAL REVIEWERS

Joint Commission logo
National Patient Safety Goal 14.01.01
Pressure Ulcers (Risk assessment tools, preventative actions)

Joint Commission Accreditation Manual

CMS logo
Centers for Medicare and Medicaid Services (CMS)

Magnet Recognition

Magnet_logoThe American Nurses Credentialing Center (ANCC) requires Magnet-designated organizations to track nationally-benchmarked nursing sensitive indicators (NSIs) to continually inform improvement efforts related enhancing patient outcomes. Examples of NSIs include, but are not limited to: patient falls, hospital-acquired pressure ulcers, blood stream infections, ventilator-associated pneumonia, and restraint use.

GLOSSARY OF TERMS
There are numerous terms and acronyms in healthcare that may be unfamiliar. Please click here to visit a Glossary of Terms that may be helpful. And please email any suggested additions.

This month's featured term: Skin Failure
Skin Failure is “an [ unavoidable ] event in which the skin and underlying tissue dies due to hypoperfusion [ as a consequence of ] concurrent severe dysfunction or failure of other organ systems (Langemo & Brown, 2006).” Skin failure may occur simultaneously, but must be differentiated from, pressure injuries (PI) prior to labeling and reporting skin discoloration, necrosis, or a cavitary wound as a PI. “Failing skin” increases susceptibility to the forces of pressure and shear (White-Chu & Langemo, 2015). However, PI occur as a result of unrelieved pressure, usually over a bony prominence or under a medical device, with resultant tissue deformation, ischemia and necrosis (Delmore, Cox, Rolnitsky, et.al., 2015). PI may occur in healthy persons as well as those with coexisting illness. In contrast, skin failure “mirrors” critical illness manifested by hemodynamic instability and / or major organ compromise. Peripheral arterial disease, mechanical ventilation greater than 72 hours, respiratory failure, liver failure, and severe sepsis / septic shock have been shown to be significant and independent predictors of acute skin failure in critically-ill patients (Delmore, 2015).
Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.
If you have questions or suggestions related to the EED portal, please contact Georgia Peirce at (617) 724-9865 or via email at gwpeirce@partners.org.

Updated 9/17

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