hospital acquired pressure ulcers
DESCRIPTION
Hospital Acquired Pressure Ulcers. Background – Harm. Incidence of Stage II or greater > Hospital-Acquired Pressure Ulcers ranges from 5% - 9 % 60, 000 die from pressure ulcer complications each year. Background – Harm. Decrease quality of life and functionality - PowerPoint PPT PresentationTRANSCRIPT
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Hospital Acquired Pressure Ulcers
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Background – Harm
• Incidence of Stage II or greater > Hospital-Acquired Pressure Ulcers ranges from 5% - 9%
• 60, 000 die from pressure ulcer complications each year
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Background – Harm
• Decrease quality of life and functionality
• Increase risk of other complications
• Increase hospital mortality
• Increase need for skilled care and rehab after discharge
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Who get’s pressure ulcers?
• Spinal cord injuries & elderly
• Higher incidence in hospitals (38%) not nursing homes (23.9%)
• Pressure ulcers do not always signify poor care
Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: A systematic review. JAMA. 2006;296:974-984.
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Co-Morbidities
Diabetes Heart disease
Renal disease
Dementia Malnutrition
Age 70 or greater
Impaired mobility
Physical restraints
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Pathogenesis for HAPU
Friction Shear Force
Moisture Temperature elevation
Sensory impairment
Oxygen deprivation
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Friction
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AIM
• Reduce the prevalence of hospital acquired Stage II or greater pressure ulcers from 2010 baseline rate by 50% by December 31, 2013
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Suggested Measures
Outcome• Patients with at least one
Stage III or greater hospital acquired pressure ulcer
Process• Skin assessment
documented within 24 hours of admission
• HAPU risk assessment completed within 24 hours of admission
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Reduce HAPU by 50%
Conduct Skin/Risk AssessmentHead-to-toe skin & risk assessment
Assess on admission & reassess daily
Manage MoistureKeep skin dry & protected
Optimize Hydration & NutritionAssess weight
Assess nutrition & hydration status
Minimize Pressure, Shear, & FrictionTurn & reposition patients every 2 hours
Early mobility/ambulation
AIM Primary Driver Secondary Driver
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Primary Driver: Conduct Skin & Risk Assessment
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Head to Toe Risk Assessment
• Within 4 hours of admission
• At least every day• Check skin during
routine care, i.e. turning, bathing
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Take Action!
• Plan of care & interventions based on skin & risk assessment
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Include Skin Risk in Handoffs
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Primary Driver: Manage Moisture
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Balance Need for Dry but Moisturized Skin
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Use Under Pads to Keep Skin Dry
Will hold up to 1 liter
& Keep skin dry!
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Use ‘Reminders”
P = PainP = PottyP = Position or Pressure
3 P’s
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Primary Driver: Optimize Hydration & Nutrition
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Monitor…
• Weight• Hydration status
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Offer Appetizing Food & Drink Choices
• Tempt patient with food & drink they like
• Consider cultural food preferences
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Additional Interventions:
• Consult a registered dietician
• Consider nutritional supplements
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Primary Driver: Minimize Pressure, Shear, & Friction
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Turn! Turn! Turn!
• Turn & reposition at least every 2 hours
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Pressure Relieving Special Surfaces & Tools
• Foam wedges to position patients
• Special pressure redistributing/relieving mattresses
• Use pillows only for limbs
• Heel boots
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Early Mobility & Ambulation
Staff driven protocol Get patients moving!• Includes assessment of
patient strength & weaknesses
• Includes ‘opt out’ for contraindications
• Triggers referral to physical therapy based on criteria
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Minimizing Shear & Force
• Use lifts to reposition• Breathable glide sheets• Limit linen layers to no
more than 3• Foam sacral dressing
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Key Resources
• AHRQ Toolkit: Preventing Pressure Ulcers in Hospitals• AHRQ Guideline Synthesis on Preventing Pressure Ulcers• National Pressure Ulcer Advisory Panel• IHI: How to Guide on Reducing Pressure Ulcers• Hughes RG (ed). Patient Safety and quality: An evidence-
based handbook for nurses. AHRQ Publication No. 08-0043, Rockville, MC: Agency for Healthcare Research and Quality; April 2008
• Gibbons W, Shanks HT, Kleinhelter P, Jones P. Eliminating facility-acquired pressure ulcers at ascension health. JC J Qual Pt Safety. 2006;32(9).488-496.