where oh where has our *puppy gone…
DESCRIPTION
Where oh where has our *PUPPY gone…. *Pressure Ulcer Prevention Plan Yesterday. Meet Our Nursing Home!. Quaint Home nestled in South Dakota’s back roads 50 Residents 55 beds 70 Caring Staff Members 2 cats 1 dog 20 fish. Our Quarterly Quality Improvement Team. Medical Director - PowerPoint PPT PresentationTRANSCRIPT
1
Where oh where has our *PUPPY gone…..
*Pressure Ulcer Prevention Plan Yesterday
2
Meet Our Nursing Home!
Quaint Home nestled in South Dakota’s back roads
50 Residents 55 beds
70 Caring Staff Members2 cats1 dog20 fish
3
Our Quarterly Quality Improvement Team
Medical DirectorDirector of NursingESS Director (Safety)AdministratorConsulting PharmacistQuality Assurance Coordinator RN (rotates quarterly)C.N.A. (rotates quarterly)
4
Our QI ‘Sub Team’
Team members from each department Led by QI coordinator Meet monthly Small committees beginning and ending within
this team
5
Our Care Plan Team….
Director of NursingSocial ServicesMDS CoordinatorRestorative CoordinatorActivitiesDietary ManagerDay Shift C.N.A (rotates)Evening Shift C.N.A (rotates)
6
Our Saga begins!
DON wondered how many of our nosocomial pressure ulcers currently have documentation for signs of Stage 1 pressure ulcers Worksheet A completed
• 5 Charts reviewed – 40% have documentation supporting Stage 1
– 60% have no documentation supporting Stage 1
7
Help! We can’t do this alone!
A team is needed!An invitation was developed!
Posted • in bathrooms
• staff break rooms
• by time clock Inserted in pay checks
8
Bored?
Lonely?
Want more fun?
Like to make a difference?
Care about pressure ulcers?
Want to help create excitement?
Stop by Susan’s office to find out more!
Invitation...
9
Looking for excitement?
You’ve come to the right place!
A new pressure ulcer team is in the making!
You’re invited to join!
June 5, 2003 - 2:30 p.m.
Conference Room
Desire to make a difference necessary!
See you there!
Sign hanging in Susan’s office...
10
Our Team Takes Shape!
C.N.A – EveningC.N.A. – DayQuality Improvement CoordinatorRN – DayRN – NightDietary AssistantActivities Assistant
11
First Meeting!!
Guidelines set by team members• No finger pointing or blaming allowed!
• Weekly meetings every Tuesday at 2:30 pm– Goal of 60 minute meetings --eventually to 30 minutes
• Snack at each meeting - ask dietary!
• Keep notes of each meeting! - Note Taker needed!
• Start on time, end on time - Time Keeper needed!
12
Celebrate small successes bulletin/story board --need volunteers!
No questions considered ‘dumb’ All ideas have equal weightHave Fun!!Keep meetings on task
need a leader!
No Negativity Allowed!
13
Team Goal-Worksheet D
Increase the number of charts that reflect documentation of nosocomial Stage 1 pressure ulcers prior to development of nosocomial Stage 2 or Stage 3 pressure ulcers from 40% to 75% by July 1, 2003.
14
Worksheet E – Current Process
Discrepancies noted in current process for pressure ulcers! Everyone has their own way!! Flow sheet created
• ‘Pressure Ulcer Prevention Flowchart’
15
Taking it to the Fishbone!!
Worksheet G used as a guide Problem in process - pressure ulcers are not
reported until they are a stage 2 Ask why pressure ulcers are not reported until
they are a Stage 2.• Proceed with fishbone
16
Why are pressure ulcers not identified until Stage 2 or 3?
EnvironmentEquipmentPeople
unaware of residents at risk unaware of Policy & Procedure if reported, no follow-up completed unaware of risks and signs of Stage 1
17
Fishbone - Worksheet G Continued‘Why are pressure ulcers not identified until Stage 2 or 3?’
Methods/Processes No risk assessment No procedure
Materials Forms not available when needed
18
Brainstorming Solutions - Worksheet H
Unaware of Policy & Procedure educate
Filing cabinet not in order organize
Forms not available when needed yellow sticky on master - educate staff to make copies
prior to running out!
If reported, no follow-up educate
19
Solutions continued...
Unaware of residents at risk implement PUPPY pictures
No risk assessment Implement Braden Scale and protocols
No procedure for C.N.A.s to report implement PUPPY body cards
20
Third Meeting!
Priorities Set!! Revise Policy & Procedure Risk Assessment Form PUPPY pictures PUPPY Body Cards for reporting Organize Filing System Staff Education
Gathering of examples and samples begins! Fellow nursing home teams Surf web
21
Review Policy & Procedure
Include Braden Risk Assessment FormProtocols
Implementation Plan – Worksheet I used• Goal – All residents will have Braden completed by
Sept 30 – Begin with new admissions
– Weekly according to MDS schedule
22
Review Policy & Procedure
PUPPY picture cards Implementation Plan (worksheet I)
• PUPPY cards will be implemented with Braden Scale. Nurse will place them when resident identified at risk per Braden Scale
• Evaluation – random 10% staff interview
23
Review Policy & Procedure
PUPPY body cards Implementation Plan (worksheet I)
• C.N.A. will complete and Log
• Give to CN
• CN gives to MDS Coordinator after documentation and care plan updated
• C.N.A.s will receive education on 6/3/03
• Will discuss further at 6/3/03 meeting
24
Fourth Meeting
PUPPY Rollout discussed PUPPY Fair
• Stations decided on
• Prizes
• Flyer designed
• Each team member volunteered for tasks
25
We can prevent pressure ulcers!
Join us at the PUPPY Fair
to find out more!
June 15 - 1 p.m. - Dining Room
See you there!
26
It’s coming!
PUPPY Fair
June 15 - 1 p.m. - Dining Room
See you there!
27
Department Heads Needed!
QI Coordinator updates at weekly department head meetings each department head was given list of current
staff members in their department• contact staff members and ask if they’re planning to
attend the PUPPY fair
• if staff replies yes, a coupon is given to staff
28
Name__________ Department__________
This coupon entitles bearer to: One free bag of puppy chow
Must be redeemed upon registration during
PUPPY Fair! Offer good only June 15, 2003
29
PUPPY Fair Booths
PUPPY Picture Booth colored PUPPY pictures
• laminated and cut out poster explaining purpose and directions for use
Need a staff member to explain booth!
30
31
Managing Moisture Booth
Incontinence products used to keep residents dry
Moisture barrier cream (if your home uses it) demonstration
Poster explaining importance of managing moisture
Nurse to explain booth
32
‘Oh What a Relief it is!’ Booth
Sample of all pressure relieving devices currently used
Poster for booth Nurse to explain booth
33
This Price is Right! Booth
Participants guestimate costs of pressure ulcers pressure ulcer prevention pressure ulcer treatments
A picture of a real wound and costs associated with healing could make a big impact on staff!
34
Getting Picky With It BoothBooth set up with equipment
with cracks• infection control issues
• causing skin tears worn out
• no longer serving its purpose
Educate staff on the need to have equipment fit and be in good condition for our residents in order to prevent skin tears, pressure ulcers and infections
35
Rolly Polly PUPPY Booth
Educates staff on our current turning schedule for residents at risk
36
Food, Water and Pressure Ulcers Booth
Create awareness in staff Importance of snacks food intake importance of documentation special interventions
• colored napkins, or other ‘systems’ designed to alert staff to ‘at risk’ residents
37
PUPPY Team Goals and Progress Booth
Storyboard or bulletin board‘Take the Pledge’ form for staff to sign
38
How Much Pressure Does it take to Cause a Pressure Ulcer? Booth
Create awareness that it takes 60 mm to create a pressure ulcer dry skin and applying socks create sheering
• use onion and have staff apply sock!
• Use lotion and have them determine if it decreases sheering!
39
Sheering Effects Booth
Increase awareness effects sheering has on residents’ delicate skin importance of preventing sheering
40
Residents Skin is Just ‘Plum’ Thin Booth
Demonstrate how thin residents’ skin isIncrease awareness to use care with skin
41
Fifth Meeting
Braden Scale education for nurses Braden Scale process and protocols set up
Filing system
Training Session for C.N.A.s set
42
Questions?
QI ProcessArea in need of improvementCollecting DataBrainstormingPlanningImplementingFollow through