The Miriam Hospital has received the 2009 Advancing Innovation in Healthcare Hospital Award by Quality Partners of Rhode Island. The hospital was recognized for successfully implementing a new initiative to prevent hospital-acquired pressure ulcers in the intensive care unit (ICU). The program resulted in a preliminary 100 percent decrease in pressure ulcer rates after six months.
Jennifer Sargent, RN, MSN, NE-BC, nurse manager of The Miriam's ICU, and Debbie Bartula, MSN, an ostomy and wound nurse, spearheaded the project and accepted the award on behalf of the hospital.
Pressure ulcers, or bed sores, typically occur among patients who can't move or have lost sensation. They commonly form where bones are close to the skin, such as the ankles, back, elbows, heels and hips. According to the Agency for Healthcare Research and Quality, hospitalizations involving patients with pressure ulcers - developed either before or after admission - increased nationwide by nearly 80 percent between 1993 and 2006.
Preventing pressure ulcers is a national safety concern, said Arthur Sampson, executive director of The Miriam Hospital. Although we were already very progressive in our efforts to prevent pressure ulcers, we wanted to look at additional ways we could continue to improve patient outcomes. By taking a more collaborative, team-based approach, we saw a complete reduction in ulcer rates in just a short time. This award recognizes the dedication of the entire team and our overall commitment to providing the highest quality patient care.
Earlier this year, Miriam ICU leadership pulled together key staff from every department within the hospital involved in pressure ulcer prevention and documentation, including nursing, physicians, wound care, education, leadership, social work, physical therapy, nutrition and medical coding. They identified a number of specific challenges, including communication across the caregiving teams and the importance of nutrition - particularly high-protein diets that can encourage wound healing and prevention.
Within a month, the team developed and implemented the following interventions:
Risk assessment and skin condition routinely discussed on daily rounds with patient care team as well as during all standard nurse-to-nurse reports.
Continued bi-weekly multidisciplinary rounds conducted by nursing, social work, physical therapy, nutrition and the wound/ostomy nurse to identify patients at high risk.
Nutrition consults on all patients.
Focus on nurse/physician documentation related to risk and skin assessment, pressure ulcer documentation and conditions present on admission.
Any changes in a patient's skin condition are brought to the nurse's attention by certified nurse assistants.
Utilization of vendors and other experts for unit education and optimization of products they supply.
Data collection revealed that by July 2009 - six months after the program launched - there were no incidents of hospital-acquired press ulcers in the ICU. The national average is approximately seven to ten percent.
The support of hospital leadership and staff buy-in to these new protocols were critical to our success, since everyone from nurse assistants to physical therapists to nutritionists have important and unique roles in providing patient care, said Sargent. This truly was a team effort.
Bartula added that continued success depends on daily communication among all caregivers and documentation of the new interventions. Moving forward, we need to maintain a continued collaborative approach, keep the emphasis on prevention and risk assessment, perform frequent audits of compliance and conduct daily discussion of interventions across all departments, she said.
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