ArticlePDF Available

Embracing the Use of Skin Care Champions

Authors:
Nursing Management December 2009 19www.nursingmanagement.com
Regulatory readiness
Embracing the use of
skin care champions
By Sandra Bergquist-Beringer, RN, CWCN, PhD; Kelly Derganc, RN, BSN;
and Nancy Dunton, PhD
N
ational focus on pressure ulcers is the
result of studies that reveal an increase
in the number of patients who have
them and poor compliance with clinical
practice guidelines on pressure ulcer
prediction and prevention.1–4 Pressure
ulcer-related hospitalizations have also been
found to be two times longer and more costly
than many other hospitalizations. Medicare
and Medicaid pay about 75% of these costs.5
The Centers for Medicare and Medicaid Serv-
ices no longer reimburses hospitals for the
treatment of hospital-acquired Stage III and IV
pressure ulcers because most are reasonably
preventable with evidence-based care.6Hospi-
tals now find themselves reviewing their orga-
nizational policies and practices to improve
pressure ulcer prevention processes and
outcomes.
The literature identifies seven organizational
factors that are important to quality improve-
ment success:
strong administrative support
active board of directors involvement
multidisciplinary involvement
expert performance improvement staff
effective quality data systems
individual staff-level involvement and
accountability
effective communication structures and
processes.7
One study found that four of the factors were
critical to improving patient-safety outcomes:
directly involving top- and middle-level lead-
ers; aligning improvement efforts and organiza-
tional priorities; establishing infrastructure
processes to evaluate performance for ongoing
quality improvement; and developing champi-
ons, teams, and staff.8
The role of champions has often been exam-
ined in management literature. Champions are
opinion leaders, facilitators, or change agents
who promote the use of evidence-based prac-
tice.9Their activities are based on increasing
recognition that communication and interactive
social process are key factors in knowledge
diffusion and implementation of research into
practice.10–12 Champions adopt care manage-
ment processes that achieve effective and safe
care and mobilize their colleagues’ involvement
in these quality improvement projects.8They’re
advocates of new ideas or initiatives and work
diligently to promote them.12 Personal owner-
ship of the idea, initiative, or quality improve-
ment project is a central feature of the role.
Champions are trained for the job but must also
possess strong communication and interpersonal
skills and the ability to influence others to prac-
tice evidence-based care. In addition, champions
must be recognized as credible by those with
whom they work and senior management.8
The Institute for Healthcare Improvement
(IHI) recommends hospitals consider using skin
care champions within the hospital or in each
unit.13 However, we know little about the role
and responsibilities of skin care champions in
pressure ulcer prevention and outcomes. A lit-
erature search on PubMed and CINHAL from
1994 to June 2009 was performed using the
keywords pressure ulcer prevention, skin care
champions, and skin care teams. In addition,
abstracts of studies and quality improvement
projects approved for presentation at the
3rd Annual National Database of Nursing Qual-
ity Indicators (NDNQI) Data Use Conference
held in January 2009 and the 41st Annual
Wound, Ostomy and Continence Nurses
Annual Conference held in June 2009 were
reviewed for reference to the use of skin care
champions in these studies or quality improve-
ment projects. Examples of success stories
related to pressure ulcer prevention posted
on IHI’s website were also examined. Each
of the 5 journal articles, 13 abstracts, and
Regulatory readiness
www.nursingmanagement.com20 December 2009 Nursing Management
4 success stories identified were
analyzed to determine the role and
responsibilities of skin care champi-
ons in pressure ulcer prevention
and outcomes.
What makes a champion?
Skin care champions are either
internal or external to an organiza-
tion and act in a formal role to
improve pressure ulcer practice.
The Canadian Association of
Wound Care created a Pressure
Ulcer Awareness and Prevention
(PUAP) quality improvement pro-
gram that assigns a skin care cham-
pion who has wound and skin care
experience to each interested
healthcare facility to spearhead the
PUAP program.14 This skin care
champion acts as a coach for the
facility pressure ulcer team, edu-
cates facility staff, and promotes
self-sustaining change. However,
the relationship between the skin
care champion and healthcare
facility is often short-term or time-
limited, and research has shown
that improvements in pressure ulcer
practice may not be maintained
after a skin care champion leaves
the healthcare facility.15 Skin care
champions who are internal to the
organization build longer-term rela-
tionships and are recommended for
successful system redesign.
Most skin care champions are
unit-based because studies have
found that overcoming resistance to
change often requires a champion
who’s “one of their own” and can
“speak the language” of the staff
members they’re trying to sway.16,17
Unit-based skin care champions are
nurses who may be recruited by
nursing management or administra-
tion based on their champion capa-
bilities, or they may volunteer for
the role out of personal or profes-
sional interest in skin and wound
care.18 These skin care champions
receive intensive training on evi-
dence-based pressure ulcer practice
that may include one-on-one educa-
tional sessions with a certified
wound-ostomy-continence nurse,
initial and ongoing formal classes
and workshops, or an extended clin-
ical practice fellowship.19–21 Skin
care champions are empowered to
assist with decision making regard-
ing skin care in their unit and are
provided dedicated time to engage
MASTER OF SCIENCE NURSING IN
Nursing Administration
and Leadership
100% ONLINE >STARTING JANUARY 2010
California University of Pennsylvania
School of Graduate Studies and Research
Building Character. Building Careers.
A proud member of the Pennsylvania StateSystem of Higher Education.
Nurse administrators & leaders
• NEW 100% ONLINE MSN PROGRAM
• QUALITY EDUCATION AND LOW TUITION
• 20-MONTH PROGRAM
California University of Pennsylvania’s 100% ONLINE Master of
Science Nursing (MSN) in Nursing Administration and Leadership
prepares advanced practitioners to address prevailing health and
nursing issues, develop a comprehensive understanding in nursing
research, and establish a foundation for doctoral study in nursing.
The MSN program is designed to foster strong and visionary leaders
who are competent in all dimensions of the role, including:
• nursing theory and research • health policy
• health promotion/disease prevention • healthcare finance
• organization and management • legal and ethical practice
• delivery systems of patient care • humanresource management
CALU
GLOBAL ONLINE
TO LEARN MORE, please
e-mail msnonline@calu.edu,
call 1-866-595-6348 or visit
www.calu.edu/go/nursing.
Regulatory readiness
www.nursingmanagement.com22 December 2009 Nursing Management
in skin care quality improvement
initiatives.
Skin care champions promote
evidence-based pressure ulcer pre-
vention care and encourage needed
practice changes at the unit level.22,23
They serve as the unit resource for
pressure ulcer prevention care, edu-
cate and update unit staff on pres-
sure ulcer practice issues, and assist
the staff to develop individualized
plans of prevention for patients in
the unit.18,19,24,25 These champions
round on unit patients who are iden-
tified as being at risk for pressure
ulcers to ensure implementation of
pressure ulcer prevention interven-
tions, perform chart reviews to
monitor compliance, and identify
unit-level barriers to providing
evidence-based prevention care.23–26
They participate in facility pressure
ulcer incidence and prevalence stud-
ies and communicate results to unit
staff, the unit manager, the nursing
quality improvement committee,
and nurse administrators.18,20,24
(See Table 1.) Successes are recog-
nized and celebrated.26,27 For all
incident pressure ulcers in the unit,
champions conduct a medical record
review to determine the cause and
develop an action plan for process
improvement.23,25 It’s important that
unit staff feel direct and active own-
ership of the redesign efforts.8
Creating teams
Unit-based skin care champions
meet together weekly or monthly.
The skin care champion team is
usually chaired by one or more
certified wound care nurses and
may be attended by performance
improvement staff and other nurse
leaders.21,23,24 The purpose of the
team meetings is to review unit
pressure ulcer prevalence and
incidence results and unit root
cause analysis results, address pres-
sure ulcer prevention issues, and
discuss unit-level improvement
experiences.18,23–25 Progress reports
are usually shared at all levels of
the organization to promote
accountability and encourage
ongoing achievements.26,28
The skin care champion team is
responsible for the education of
new staff on pressure ulcer quality
of care and the ongoing education
for all staff on pressure ulcer pre-
vention, identification, and care
issues.29,30 The skin care team is
also responsible for standardizing
pressure ulcer prevention and
other facility-wide skin care proto-
cols and recommending modifica-
tions to documentation processes
to include evidence-based pressure
ulcer prevention care.21,31,32 For
example, the patient admission
assessment may be enhanced to
include a skin inspection for pres-
sure ulcers or the 24-hour nursing
documentation may be modified to
include pressure ulcer risk assess-
ment and preventive care. The
team trials new skin care products,
makes decisions on support sur-
faces, and standardizes specialty
bed and surface use.18
Improving outcomes
Use of skin care champions in pre-
vention programs has improved
pressure ulcer outcomes. Hospitals
that included unit-based skin care
champions in a pressure ulcer
prevention program commonly
reported a 40% to 50% decrease in
hospital-acquired pressure ulcers
rates; in some cases a 70% to 80%
reduction was noted.24,33 At OSF
Saint Francis Medical Center in
Peoria, Ill., the rate of hospital-
acquired pressure ulcers was
reduced from 9.4% to 1.8% over
a 5-year period when skin care
champions were one of the Six
Sigma strategies.23 One study
reported a 50% reduction in
hospital-acquired pressure ulcers
within 9 months of implementing
a pressure ulcer program that
involved use of unit-based skin
care champions; financial benefits
from the project included a 1.2 mil-
lion cost savings.21 At Ascension
Health, skin care champions
helped to reduce the incidence of
pressure ulcers from greater than
2% to less than 1%.26 Pressure ulcer
severity also declined and no new
Stage III or IV pressure ulcers
developed from 2004 to 2006.
Owensboro Medical Health System
in Owensboro, Ky., reduced its rate
of hospital-acquired pressure
ulcers from 24% to 0% over a 5-
year period with the assistance of
skin care champions.32
Increased staff knowledge and
use of evidence-based prevention
interventions were commonly
noted.25 Onslow Memorial Hospi-
tal in North Carolina achieved a
98% to 100% compliance with
24-hour nursing assessments,
pressure ulcer prevention inter-
ventions, and risk assessment
scoring when unit-based skin care
champions were included in the
prevention program.29 Additional
benefits included the formation of
a consistently well-trained pool of
data collectors for more reliable
results from prevalence and inci-
dence studies.25
Bringing prevention to the bedside
Pressure ulcers are a serious health-
care problem and the target of care
quality reform. Review of the litera-
ture suggests that skin care champi-
ons improve the quality of pressure
ulcer prevention and reduce the
rate of hospital-acquired pressure
ulcers. Although use of skin care
champions is one component in
a comprehensive pressure ulcer
prevention program that requires
multidisciplinary effort, it brings
Regulatory readiness
www.nursingmanagement.com24 December 2009 Nursing Management
evidence-based pressure ulcer pre-
vention to the bedside, mobilizes
unit staff responsible for quality
improvement, and increases unit
accountability for providing safe
and effective care.
NM
REFERENCES
1. Agency for Healthcare Quality and
Research. Pressure ulcers increasing
among hospital patients. http://www.
ahrq.gov/news/nn/nn120308.htm.
2. Bergquist S. The quality of pressure
ulcer prediction and prevention in
home health care.
Appl Nurs Res.
2005;18(3):148-154.
3. Lyder CH, Preston J, Grady JN, et al.
Quality of care for hospitalized
medicare patients at risk for pressure
ulcers.
Arch Intern Med.
2001;161(12):
1549-1554.
4. Saliba D, Rubenstein LV, Simon B, et
al. Adherence to pressure ulcer pre-
vention guidelines: implications for
nursing home quality.
J Am Geriatr
Soc.
2003;51(1):56-62.
5. Russo CA, Steiner C, Spector W. Hos-
pitalizations related to pressure ulcers
among adults 18 years and older. 2006.
http://www.hcup-us.ahrq.gov/reports/
statbriefs/sb64.pdf.
6. Clancy CM. CMS’s hospital-acquired
conditions lists link hospital payment,
patient safety.
Am J Med Qual.
2009;24
(2):166-168
7. Barron WM, Krsek C, Weber D, Cerese
J. Critical success factors for perform-
ance improvement programs.
Jt Comm
J Qual Patient Saf.
2005;31(4):220-226.
8. Wang MC, Hyun JK, Harrison M,
Shortell SM, Fraser I. Redesigning
health systems for quality: lessons
from emerging practices.
Jt Comm J
Qual Patient Saf.
2006;32(11):599-611.
9. Doumit G, Gattellari M, Grimshaw J,
O’Brien MA. Local opinion leaders:
effects on professional practice and
health care outcomes. http://www.
mrw.interscience.wiley.com/cochrane/
clsysrev/articles/CD000125/frame.html.
10. Backer, TE. Knowledge utilization.
Sci
Comm.
1991;12(3):225-240.
11. Rogers EM.
Diffusion of Innovations.
4th ed. Toronto, Canada: The Free
Press; 1995.
12. Thompson GN, Estabrooks CA, Degner
LF. Clarifying the concepts in knowl-
edge transfer: a literature review.
J
Adv Nurs.
2006;53(6):691-701.
13. Institute for Healthcare Improvement.
Prevent pressure ulcers: Getting
started kit. http://www.ihi.org/IHI/Pro-
grams/Campaign/PressureUlcers.htm.
14. Orsted HL, Rosenthal S, Woodbury
MG. Pressure ulcer awareness and
prevention program: a quality improve-
ment program through the Canadian
Association of Wound Care.
J Wound
Ostomy Continence Nurs.
2009;36(2):
178-183.
15. Xakellis GC, Frantz RA, Lewis A,
Harvey P. Translating pressure ulcer
guidelines into practice: it’s harder
than it sounds.
Adv Skin Wound Care.
2001;14(5):249-256,258.
16. Barker KK, Bosco C, Oandasan IF. Fac-
tors in implementing interprofessional
education and collaborative practice
initiatives: findings from key informant
interviews.
J Interprof Care.
2005;
19(Suppl 1):166-176.
17. Saint S, Kowalski CP, Banaszak-Holl J,
Forman J, Damschroder L, Krein SL.
How active resisters and organiza-
tional conspirators affect health care-
acquired infection prevention efforts.
Jt Comm J Qual Patient Saf.
2009;35(5):
239-246.
18. Stoelting J, McKenna L, Taggart E,
Mottar R, Jeffers BR, Wendler MC.
Prevention of nosocomial pressure
ulcers: a process improvement proj-
ect.
J Wound Ostomy Continence
Nurs.
2007;34(4):382-388.
19. Cowie K. Skin care champions making
a difference in the ICU.
CACCN.
2008;
19(2):37.
20. Duke University Medical Center. Put-
ting the pressure on pressure. http://
inside.duke.edu/article.php?IssueID=
162&ParentID=15245l.
21. Garza S, Okere V, Igbinoba J, Novosad
K. Reducing hospital-acquired pres-
sure ulcers. http://www.psqh.com/
marapr06/sixsigma.html.
22. Wound, Ostomy and Continence
Nurses Society.
Guideline for Preven-
tion and Management of Pressure
Ulcers.
Glenview, IL: WOCN; 2003:11-17.
23. Griffin B, Cooper H, Horack C, Klyber
M, Schimmelpfenning D. Best practice
protocols: reducing harm from pres-
sure ulcers.
Nurs Manage.
2007;38(9):
29-31,69.
24. Courtney BA, Ruppman JB, Cooper
HM. Save our skin: initiative cuts pres-
sure ulcer incidence in half.
Nurs
Manage.
2006;37(4):36,38,40.
25. Salisbury C, Dingley C, Johnson D,
Rose C, Rees K. The PUPPI (Pressure
Ulcer Prevention Performance
Improvement) Program: Waging
war on wounds. Poster presented
at: the 3rd Annual NDNQI Data Use
Conference; January 21-23, 2009;
Dallas, TX.
26. Gibbons W, Shanks HT, Kleinhelter P,
Jones P. Eliminating facility-acquired
pressure ulcers at Ascension Health.
Jt Comm J Qual Patient Saf.
2006;32(9):
488-496.
27. Maklebust J. Pressure ulcers: the
great insult.
Nurs Clin North Am.
2005;40(2):365-389.
28. Daniels MJ, Cann-Taylor J, Diamond V.
Linking nursing staff, unit, and divi-
sions performance with nursing sensi-
tive quality indicators. Poster pre-
sented at: the 3rd Annual NDNQI Data
Use Conference; January 21-23, 2009;
Dallas, TX.
29. Hayden C. Champions improve staff
education and compliance with pres-
sure ulcer prevention strategies.
http://www.ihi.org/IHI/Topics/Medical
SurgicalCare/MedicalSurgicalCare
General/ImprovementStories/Champions
ImproveStaffEducationCompliance
PressureUlcerPrevention.htm.
30. Meyers T. Skin care team reduces pres-
sure ulcer prevalence and incidents dis-
trict-wide. Poster presented at: the 3rd
Annual NDNQI Data Use Conference;
January 21-23, 2009; Dallas, TX.
31. Conti MT. Pressure ulcer prevention
success in an integrated healthcare
system (abstract).
J Wound Ostomy
Continence Nurs.
2009;36(3S):S27.
32. Jones M. Pressure ulcer prevention:
Our journey (abstract).
J Wound Ostomy
Continence Nurs.
2009;36(3S):S44.
33. Pinches A. Empowering nurses to
reduce hospital acquired pressure
ulcers. Poster presented at: the 3rd
Annual NDNQI Data Use Conference;
January 21-23, 2009; Dallas, TX.
At the University of Kansas, School of
Nursing in Kansas City, Kansas, Sandra
Bergquist-Beringer is an associate profes-
sor and NDNQI pressure ulcer consultant,
Kelly Derganc is a master’s student, and
Nancy Dunton is a research professor and
NDNQI principal investigator.
Nancy Dunton, PhD, research associate
professor, University of Kansas Medical
Center School of Nursing, NDNQI, Kansas
City, Kansas, is the coordinator of the
monthly Regulatory Readiness column for
Nursing Management
.
... The program needs a house-wide policy and procedure that clarifies the evidence and best practices for pressure prevention and routines of care. Also, there is need for a continuing education program to teach skin anatomy, PI risk assessment, pressure relief interventions, interdisciplinary involvement, and products to support clinical care goals (Ahroni, 2014;Bergquist-Beringer, Derganc, & Dunton, 2009). Best practices are bundled and used as a prevention intervention package for all staff. ...
... Bundle compliance can be checked by rounding on high-risk patients and completing chart audits. Frequent sharing of compliance data with leadership and clinical staff will facilitate progress toward achieving the goal (Bergquist-Beringer et al., 2009;Kelleher et al., 2012;Niederhauser et al., 2012;Sullivan & Schoelles, 2013;Visscher, 2013). ...
... They are familiar with hospital skin care resources, as well as PI prevention products and devices. Skin Champions also work as a mentor and educator to others in the unit (Bergquist-Beringer et al., 2009;Niederhauser et al., 2012;Pasek et al., 2008;Rodgers, 2014) and employ strategies to generate enthusiasm and increase awareness about the new program to ensure staff engagement, ownership and dedication. Providing real-time data in staff meetings or newsletters and giving staff/team recognition for the improvements made are a few suggestions. ...
Article
Full-text available
Prevention of pressure injuries (PIs) in pediatric patients is an important nurse-sensitive quality goal. The PI rate at a large urban pediatric hospital triggered a call to action by the Chief Nursing Officer to establish a Hospital Acquired PI (HAPI) Task Force which identified the Skin Champion program as a key improvement strategy. The goals of the Skin Champion program are to lower the rate of HAPIs, empower front line care providers to implement evidence-based care bundles, achieve consistency of practice, and provide resource availability at the point of care. The implementation of the Skin Champion quality improvement program achieved an 85% reduction in severe harm and “reportable" HAPI incidence, which is lower than the HAPI national average in pediatric patients (Solutions for Patient Safety, 2018), and an increase in nurse compliance with the HAPI prevention bundle. The HAPI incidence rate has remained near 0.05 per 1000 patient days.
... The term resource nurse or the parallel term link nurse or nurse champion denotes a healthcare role that is established internationally and is used in a wide area of clinical settings such as infection prevention and control [1], wound and skin care [2], diabetes care [3] and palliative care [4,5]. However, neither the resource nurses' role nor the similar terms are distinctively defined [6,7]. ...
Article
Full-text available
Background The role of the resource nurse aims at bridging the gap between the specialist nurses and the nurses who work in non-specialist wards. The role is established internationally and used in a wide area of clinical settings. The resource nurse is promoting evidence-based practice. Patients with life limiting conditions including cancer and other chronic diseases will likely need palliative care during the trajectory of illness. Due to the complexity of palliative care, both interprofessional help and cooperation between levels of healthcare are considered necessary. Aim The aim of this study was to explore the perceptions and experiences related to the role of the resource nurse in palliative care in the setting of home health care services and hospitals in Norway, from the perspectives of the resource nurses and the ward nurses. Design The study has an explorative design with a qualitative approach. Methods Eight individual interviews were conducted. Audiotaped interview material was transcribed verbatim and the data were analysed using systematic text condensation. The encoded data material provided the basis for writing analytical texts that in turn resulted in meaningful descriptions of the different categories. Results Four resource nurses and four ward nurses participated in individual interviews. Analysis of the data yielded three categories: 1. Expectations of better competence in the ward. 2. Expectations of better cooperation between professions and different levels of healthcare services. 3. Improvements and hindrances. Conclusion The resource nurse role is underutilized due to heavy workload and inefficient organization of care. Improvements such as sufficient time resources, support from the ward nurse and cooperation with staff nurses, the resource nurses’ role could contribute to increased competence and cooperation interprofessionally and between levels of healthcare.
... The goal of the champion is to disseminate new knowledge and advocate for patients to promote quality, safe patient care. [31] Champions are leaders who become experts in an area of nursing practice by educational and professional development. Champions are empowered to lead their patients to improved health care outcomes by communicating information with patients, family members, and the health care team. ...
Article
Problem/Significance: Nurses may not be required to engage in professional development; however professional development has been identified as a factor to improve leadership competence, confidence, decision making, and clinical practice. Specifically, nurses who participate in professional development education improve their leadership characteristics. This study will evaluate the leadership behaviors of frontline nurses participating in professional development compared to those who were not.Methods: A convenience sample of 248 staff nurses employed in the North East region of the United States responded to the descriptive observational study design. The subjective responses to the Leadership Practice Inventory® (LPI) and demographic variables were analyzed.Results: Clinical ladder nurses scored higher on all subscales of the LPI than did nurses not on the clinical ladder. Unit-based clinical champions scored highest on the LPI regardless of the clinical ladder level or participation.Conclusions: Professional development in the form of education, certification, preceptor programs, leadership development clinical ladder programs, and unit-based champions should be considered in order to improve patient outcomes.
Article
Effective healthcare organizations sustain evidence-based practice (EBP) resulting in increased quality at a lower cost. This scoping review includes 31 articles for an overview of the evidence about EBP champion responsibilities focused on EBP sustainment. A standard role description and clarity of responsibilities could result in improved outcomes.
Article
Pressure ulcer reduction is a healthcare priority. Good clinical guidelines have the potential to transform pressure ulcer prevention and management practices. However, evidence suggests these guidelines are inconsistently utilised. The aim of this study was to explore health practitioners’ perceived barriers and enablers to the implementation of evidence‐based pressure ulcer prevention and management recommendations in an integrated community care setting. The study used a qualitative exploratory design. It took place in a community Trust in London, England. Semi‐structured interviews were conducted with a purposive sample of registered nurses and allied healthcare professionals (AHPs). The Theoretical Domains Framework (TDF) informed both data collection and data analysis. Analysis followed a five‐step process including deductive coding of the transcripts and inductive generation of specific belief statements. Nine nurses and four AHPs took part in the study. Six TDF domains were identified as most relevant to the implementation of best practice in pressure ulcer prevention and management: Goals, Knowledge, Skills, Beliefs about capabilities, Environmental context and resources and Social influences. All participants felt it was important to prevent pressure ulcers and were motivated to do so. Key enablers to the implementation of evidence‐based practice included high levels of self‐reported pressure ulcer knowledge and skills (nurses), responsive community equipment provision, the introduction of novel Pressure Ulcer Implementation Facilitator roles and integrated team working. Barriers included self‐reported deficits in knowledge and skills (AHPs), worries about inspecting intimate anatomical locations (AHPs), difficulties initiating conversations with patients about risk and behaviour change, high workloads and clutter in the home. Family members and mobile working solutions were identified as both enablers and barriers. Potential routes to addressing implementation challenges are identified and recommendations made for future research.
Article
Background: Delirium is an important issue related to mortality in patients treated in intensive care units. Local problem: Although there are guidelines for preventing delirium, its importance may be overlooked compared with the treatment of physical illness. Methods: A 2-step delirium prevention campaign (DPC) was implemented and its effects compared (before and after the DPC). Interventions: The DPC comprised the Confusion Assessment Method for the Intensive Care Unit and a checklist for delirium prevention. Results: Hospital mortality declined after the DPC, but there were no significant changes in the incidence and duration of delirium. Conclusions: Nurses led the delirium preventive care intervention. Delirium prevention care may be more effective with policy approaches to progress the DPC.
Article
Purpose: The purpose of this study was to describe occupational therapy weight-shifting practices and explore recommended strategies for patients, healthcare staff, and family/caregivers across healthcare settings. Design: Cross-sectional survey. Subjects and setting: Respondents included 97 currently practicing occupational therapists working in 5 main practice settings (ie, acute care, inpatient rehabilitation, outpatient rehabilitation, home and community care, and residential) from 9 out of 10 Canadian provinces. Methods: We created a 25-item questionnaire that included forced choice and open-ended queries. Items queried demographic information, weight-shifting techniques taught to patients, frequency and duration of weight shifting recommended, educational approaches used to teach weight shifting, and resources used to guide decision making. Participants were recruited via professional organizations and health authorities across Canada. Participants were excluded if they were not currently working with manual or power wheelchair users. Descriptive statistics were used to analyze quantitative data, and content analysis was used for qualitative data (responses to open-ended queries). Results: The most frequently recommended weight-shifting techniques were tilt (83.3%-92.8%), leaning to one side (47.9%-87.5%), and forward leaning (46.9%-83.3%). Study findings revealed a wide range of recommendations regarding frequency (every 10 minutes or less to >2 to 3 hours) and duration (≤30 seconds to as long as tolerated) of weight shifting. Weight-shifting interventions were most commonly guided by clinical experience (81.7%), practice guidelines (62.4%), and expertise of other team members (54.8%). Conclusions: Results from this study highlight the need for further research to inform weight-shifting techniques and to build a more comprehensive understanding of weight-shifting education practices.
Article
OVERVIEW: Narayana Hrudayalaya Cardiac Hospital (NHCH) in Bangalore, India (now known as the Narayana Institute of Cardiac Sciences), is one of the world's largest and busiest cardiac hospitals. In early 2009, NHCH experienced a sharp increase in the number of surgical procedures performed and a corresponding rise in hospital-acquired pressure ulcers. The hospital sought to reduce pressure ulcer prevalence by implementing a portfolio of quality improvement strategies. Baseline data showed that, over the five-month observation period, an average of 6% of all adult and pediatric surgical patients experienced a pressure ulcer while recovering in the NHCH intensive therapy unit (ITU). Phase 1 implementation efforts, which began in January 2010, focused on four areas: raising awareness, increasing education, improving documentation and communication, and implementing various preventive practices. Phase 2 implementation efforts, which began the following month, focused on changing operating room practices. The primary outcome measure was the weekly percentage of ITU patients with pressure ulcers. By July 2010, that percentage was reduced to zero; as of April 1, 2014, the hospital has maintained this result. Elements that contributed significantly to the program's success and sustainability include strong leadership, nurse and physician involvement, an emphasis on personal responsibility, improved documentation and communication, ongoing training and support, and a portfolio of low-tech changes to core workflows and behaviors. Many of these elements are applicable to U. S. acute care environments.
Article
The goal of this article is to describe the implementation of a champion model for ancillary nursing staff. As Quality Champions, nursing assistants attended specialized education classes to promote improvement in quality outcomes related to skin care, diabetes care, and prevention of catheter-associated urinary tract infections. J Contin Educ Nurs. 2015;46(12):539-541.
Article
Nosocomial pressure ulcers (PU) occur in approximately 12% of all hospitalized patients. The risk can be determined by a variety of intrinsic and extrinsic factors. As a first line of defense against nosocomial PU, we use the Braden Scale to determine the potential risk of PU development during hospitalization. Once risk was identified, our standard was to implement an individualized plan of care. However, consistent implementation of PU preventative measures was lacking. As a result, a process improvement project was developed. and implemented. The purpose of this process improvement project was to increase communication about and awareness of the need to vigorously intervene and document whenever there is risk of, or development of, a nosocomial PU. By initiating consistent use of a PU Tracking Form, developing unit-based wound champions that serve as experts in ulcer prevention, and creating an individual case analysis process, PU prevention and tracking was institutionalized. Results indicate that our nosocomial PU rate has declined from 7% to 4%.
Conference Paper
PURPOSE/PROBLEM: In 2000, this facility identified a 24% incident rate of acute care nosocomial pressure ulcers, inconsistent skin assessments and lack of a skin care plan. OBJECTIVE: To develop a skin care prevention program. The national average incidence rate of 7% was set as our short term goal, with 0% as our long term goal. METHOD: Prevalence and Incidence studies were done quarterly from 2003-2006 and bi-annually from 2006-2008. A Skin Team was formed, with a team member/champion serving each nursing unit. A skin care prevention plan was developed and continuously revised, as we narrowed our focus and learned from each setback and triumph. The shift assessment was revised and prevention strategies implemented, including changes in documentation processes, house-wide education and pressure redistribution surfaces. Other prevention initiatives included revising our skin/wound care product formulary, implementation of the Braden Scale and the development of Braden Score Interventions, skin/wound care protocols, the four-eyed admission body check, with two nurses checking the patient’s skin from head to toe, the “Pressure Points” flyer to facilitate skin care communication, a paging system to remind the staff of turn times and a magnetic “turn clock” to standardize the turning schedule and identify at risk patients at the bedside. OUTCOME: In 2008, we met our long term goal with two successive incidence rates of 0%. Since 2003, an estimated 799 pressure ulcers have been prevented, with a cost savings between $399,500 and $31,960,000. Supply savings are estimated at $102,000 annually. In 2006, this facility was recognized by the Institute for Healthcare Improvement as a Mentor Hospital for Pressure Ulcer Reduction in the 5 Million Lives Campaign. In 2007 this facilities’ skin care prevention program was featured in the The Wall Street Journal.
Conference Paper
Intermountain Healthcare (IH) has demonstrated a four fold (12.8 to 3.2) reduction in hospital acquired pressure ulcers (PrU) through a collaborative and iterative process from 2005 to 2008. IH is a health care system located in Utah and Idaho with 20 Urban and Rural Acute Care Hospitals. IH has over 2500 beds and admits over 120,000 inpatients for 500,000+ patient days. IH’s mission is to provide “excellent healthcare services to the communities in the Intermountain region”. In addition, several facilities have achieved ANA Nursing Magnet recognition during this time. Our process improvement initiative was led by a multi-disciplinary system-wide team including champion teams at each facility. The system team has standardized care protocols, wound and skin care products (dressings, lotions, skin protectants, etc.), mattresses, and clinical education. Collaboration with multiple vendor partners for products and education allowed IH to achieve significant improvement. Examples of partnership and standardization include purchase of pressure relieving support mattresses for all general medical surgical beds that yielded an immediate reduction of PrUs from 10.3, in first quarter 2006 to 4.5 by year end. Additional gains based on standardization of wound and skin care clinical protocols, products, and required education have yielded a continued reduction of PrU to an average quarterly prevalence rate of 3.6 (third quarter 2008 was 3.2). Examples of protocols include; pressure ulcer prevention guideline, PrU staging and assessment, skin care and assessment, acute wound care, chronic wound care, paper charting forms, computer charting screens, etc. Examples of products include; dressings, lotions, tapes, soaps, protectants, and barrier creams. Examples of education include focus on standardization with; posters, flyers, campus specific work shops in partnership with preferred product vendors, and required online training through IH's learning management system for PrU assessment, staging, wound care, skin care, PrU prevention.
Conference Paper
Purpose: Although the maintenance of skin integrity is a leading nursing quality of care indicator, the importance of skin care may be minimized in the acute care setting with many competing care priorities. Significance: Holy Name Hospital was faced with a 10% hospital acquired pressure ulcer rate in 2002. PI data showed variations in nursing practice and inconsistent use of wound care supplies and support surfaces. The initial goal was to meet the NDNQI benchmark and later to meet or exceed HealthGrades benchmark. Strategy and Implementation: The Nursing Division educated and empowered unit nures as Skin Care Resource Nurses (SCRN's)on all shifts. These nurses attended a full day educational program offered by the WOCN and other clincial experts. In addition they meet on a quarterly basis with the WOCN to address common issues related to skin care and to get updates on the most recent evidence based wound care practices. Wound care supplies were evaluated by the WOCN and the SCRN's and standardized on all units. Criteria were established for specialty bed use and the WOCN works with Materials Management to formalize a process for bed ordering and tracking. Protocols were developed for pressure ulcer prevention and treatment. These were dispersed throughout the nursing division and education was also provided to patient care technicians by the WOCN. Targeted skin care rounds were introduced on selected units based on NDNQI data.Seminar time was budgeted for SCRN's education and to particpate in data collection. Evaluation: The incidence of hospital acquired pressure ulcers has declined from 10% in 2002 to a hospital wide average of 2.21% for the last quarter of 2007 Implications for Practice: This is a replicable strategy for education, product standardization and pressure ulcer assessment and prevention
Conference Paper
Purpose: Goal: Would a skin care team, composed of RN's and LVN's from different pavillions of a teaching hospital district, be able to work together to create skin care protocols and implement at the unit level? Background/Significance: Acquired Pressure ulcers will no longer be reimbursed by CMS and hospitals are now trying to make sure that measures are in place to prevent pressure ucler complications. The district I represent has an increased prevalence and we are looking for ways to decrease this. The district has 3 large pavillions to address for pressure ulcer prevention and only 1 WOC. It was imperative to find nurses interested in skin managment and implement a team approach to reduce prevalence and incidents of PU. Methods: This will be a Nonexperimental Research project focusing on how a skin care champion team reduced pressure ulcer prevalence and incidents district wide. The sample size will be 1000 patients and the instruments used for the study will be a pressure ulcer staging tool, measuring tape, mirrors, and reference sheet for surface information. Data collection will occur during 1 day at all three facilities. All subjects will be informed of study and will have the opportunity of not participating. Subjects who are not in room, in surgery, discharged or refuse survey will not be assessed for the study. Assessment will be documented on data collection sheet for review. Results: After evaluation of data collected, a signficant reduction in pressure ulcers was recognized. Data was reviewed in regards to pressure uclers on admission vs pressure ulcers entered to facility. It was determined that Pre-albumin levels were not being obtained to determine level of nutritional status in those patients with pressure ulcer. Support surfaces were being used appropriately until patient acquired stage 3 or 4 PU. Number of sheets and pads under the patient was also observed to measure effectiveness of beds r/t pressure ulcers. Use of barriers for skin have increased to assist with reduction of moisture complications. Critical care surfaces were upgraded to low air loss. Conclusions and Implications for Practice: Support surface is important with the reduction of pressure ulcers. Nutritional status, barriers and turning patients also play a role with prevention and reduction of pressure ulcers. The answer - Education by district skin care team. With this district wide reduction of prevalence in PU!
Article
Knowledge utilization—research, scholarly and programmatic intervention activities aimed at increasing the use of knowledge to solve human problems—is presently in its third wave of actavcty in the United States. Definitions of the field, a historical analysis of each of the three waves (1920-1960, 1960-1980, and the present), and an overview of the knowledge base on knowledge utilization are presented in a brief state-of-the-art review for this field as of 1990. Seven larger societal trends that will affect knowledge utilization in the 1990s are explored, along with four significant challenges that the field will face internally, and some suggested mechanisms for creative response.
Chapter
This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on patterns of utilization and costs for adult hospital stays involving the treatment of pressure ulcers in 2006. Variation in the characteristics of stays principally for pressure ulcers and hospitalizations with a secondary diagnosis of pressure ulcers are compared to stays for all other conditions. Differences in utilization are illustrated according to patient age, expected primary payer, and related conditions. All differences between estimates noted in the text are statistically significant at the 0.05 level or better.