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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

A focus on pressure ulcers —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.
AN MGH NARRATIVE

‘Maya,’ a petite woman in her late 80’s, was well known to me from a prior admission. ‘Maya’ has a lengthy medical and surgical history (diabetes, kidney disease, heart failure, high blood pressure, mild dementia, breast cancer status post a left mastectomy, meningioma, esophageal dysmoltility).  Recently, she was discharged from my unit to a rehabilitation facility. A few days after discharge from rehab, she fell getting out of bed at home.  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
(point prevalence = % of patients)

CLICK HERE for additional data

ALL STAGES
STAGES II or GREATER
TREND:  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.
TREND: 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-Mar14

Adult

MGH
NDNQI
Critical Care
7.14
6.85
Surgical
1.53
1.77
Medical
1.24
2.10
Med-Surg
6.45
1.64
Psychiatry 0.00
n/a

 

Oct-Dec13

Adult
MGH
NDNQI
Critical Care
3.13
6.85
Surgical
1.52
1.77
Medical
2.13
2.10
Med-Surg 1.56 1.64
Psychiatry
0.00
n/a
 

Jan-Mar14

Adult

MGH
NDNQI
Critical Care
7.14
6.04
Surgical
0.76
1.44
Medical
1.24
1.70
Med-Surg
3.23
1.39
Psychiatry 0.00
n/a

 

Oct-Dec13

Adult
MGH
NDNQI
Critical Care
3.13
6.04
Surgical
1.52
1.44
Medical
1.52
1.70
Med-Surg 1.56 1.39
Psychiatry
0.00
n/a
 
NDNQI Benchmark: hospitals with 500+ beds; Green = Favorable, Red = Unfavorable

**Benchmarked against Oct - Dec 2013 benchmarks. Actual benchmarks will be provided when available


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 ranged from 1.3% in March 2012 to 2.8% in March 2013, including almost exclusively Stage 2 PrU.

SOS Toolkit

Policies, Procedures & Guidelines:
(TROVE: internal access only)

2.7.1 Wound Care Product Formulary

16-8-1 Nursing Practice Guideline For Skin and Wound Care

Skin Integrity Problem List (Internal Access Only)

Practice & Quality Subcommittee:
Skin Care -
Meets: 4th Tuesday monthly
1:00pm-3:00pm
Sweet Room, GRB 432

IN THE NEWS

Blake 6 explores barriers to using ceiling-lifts Caring Headlines, November 21, 2013

Nursing Grand Rounds (March 2013)

Staying on board the SOS campaign Caring Headlines, January 19, 2012

“Are you on board with the ‘Save Our SKIN' Campaign?" Caring Headlines, July 21, 2011

“What are pressure ulcers and how do you prevent them?" Caring Headlines, April 15, 2010

“Raising the bar on patient safety” Caring Headlines, March 4, 2010

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 (2010)

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. NPUAP Pressure Ulcer Guidelines (2009)

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 (2010)

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: Friction
Friction is defined as the resistance to motion in a parallel direction relative to the common boundary of two surfaces (NPUAP, 2007.) Friction is one of the two most common etiologies of superficial, top-down Stage 2 ulcers. The mechanism of injury associated with friction is abrasion of the epidermis, which is often caused by dragging the patient up in the bed or from one surface to another. Strategies to prevent friction injury include: 1) using the ceiling lift to reposition the patient, regardless of body habitus, 2) covering bony prominences with dressings (e.g. Mepilex Border Sacrum) that have slippery outer layer which decreases resistance, 3) moisturizing skin with cream containing silicon which decreases resistance (may complicate adherence of dressings with silicon at borders.
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 3/23/14

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