Magnet Recognition Program® Request for Additional Documentation
Homestead Hospital
Homestead, FL
MGN20140102
SE4EO Nurses participate in professional development activities designed to improve their knowledge, skills and/or practices in the workplace. Professional development activities are designed to improve the professional practice of nursing or patient outcomes or both. May include interprofessional activities.
SE4EOb: Provide one example, with supporting evidence, of nurses’ participation in a professional development activity that was associated with an improvement in a patient care outcome. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
Provide one example, with supporting evidence, of nurses’ participation in a professional development activity that was associated with an improvement in a patient care outcome.
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A new example is presented below.
NAME OF INITIATIVE
Decreasing Hospital-Acquired Pressure Ulcers (HAPU) in ICU
BACKGROUND/PROBLEM
A pressure ulcer is a localized injury to the skin or underlying tissue over a bony prominence. HAPUs are linked to increased length of stay; increased pain; increased risk for infection; and increased mortality. Patients in intensive care units (ICU) are more susceptible to pressure ulcer formation due to comorbidities; decreased mobility; increased medical device usage; and increased severity of illness. This population requires more attention and knowledge from the nurse to prevent HAPUs.
A sporadic pattern of HAPUs Stage 2 and above had been noted in the ICU through the National Database of Nursing Quality Indicators (NDNQI®) pressure ulcer point prevalence survey. From October to December 2013, 11.11% of ICU patients developed HAPU, higher than the NDNQI benchmark of 4.37 (for bed size 100-199). During this time, ICU did not have any representatives on the Wound Care Committee, nor did a unit-based team focus on pressure ulcer management. Additionally, ICU did not have a process in place for regular and more frequent monitoring of HAPUs.
GOAL STATEMENT(S)
To decrease the percent of patients with HAPU Stage 2 and above in the ICU.
DESCRIPTION OF THE INTERVENTION/INITIATIVE/ACTIVITIES
Nurse’s Participation in Professional Development Activity
The NDNQI benchmarked data were usually a quarter behind. Even before the October to December 2013 official numbers came out, ICU/PCU Patient Care Manager Leslie Everett, RN, knew that the HAPU numbers were higher than usual because of the prompt communication she received from Wound & Ostomy Coordinator Mary Montejo, RN, on the day the point prevalence survey was conducted. Everett’s initial step was to bring awareness on the importance of proper pressure ulcer identification and prevention. Thus, she required all ICU nurses to complete the NDNQI Pressure Ulcer Training (professional development activity). The training consisted of 4 modules, namely: 1. Pressure Ulcers and Staging; 2. Other Wound Types and Skin Injuries; 3. Pressure Ulcer Survey Guide; and 4. Community vs. Hospital/Unit-Acquired Pressure Ulcers. The ICU nurses completed them in February 2014. It took them over a period of 3 months to finish the course because of the length of the modules. They did the training either at work or on their own time. Everett paid the nurses for the time spent doing the modules out of the ICU cost center.
In March 2014, ICU Clinical Nurse Mariola Flores, RN, volunteered to become a member of the Wound Care Committee. During that same month’s meeting, the committee identified ICU as an opportunity area in the management of HAPUs. Thereafter, Montejo discussed in-depth the NDNQI HAPU report for ICU with Flores and Everett. During this discussion, they identified the need for a “back-to-basics” approach in managing pressure ulcers. Montejo suggested re-implementing the weekly prevalence rounds and gave Everett a log to assist with the data collection.
In April 2014, Montejo conducted a “train-the-trainer” session with Flores on pressure ulcer documentation and implementation of the weekly pressure ulcer prevalence rounds. By May 2014, Flores had recruited 3 more clinical nurses to join the ICU Skin Saver team, namely: Dianne Henriques, RN, Kati Franklin, RN, and Karen Ramnarine-Williams, RN. Flores, along with the new members, educated the clinical nurses and staff on pressure ulcer documentation using a checklist (professional development activity), emphasizing the importance of documenting pressure ulcers on admission (POA) to the hospital.
In May 2014, weekly pressure ulcer prevalence rounds in the ICU called “Skin Wednesdays” started. The newly formed ICU Skin Saver team facilitated the first few rounds ensuring they were completed thoroughly and accurately. They provided education and mentoring to the rest of the clinical nurses until the process became hardwired.
PARTICIPANTS
Name/Credentials |
Title |
Department |
Role in the Team |
Mariola Flores BSN, RN, CMSRN |
Clinical Nurse |
ICU |
ICU Skin Saver team leader; Wound Care Committee member |
Dianne Henriques BSN, RN, PCCN |
Clinical Nurse |
ICU |
ICU Skin Saver team member |
Vonneda Hendrickson, RN |
Clinical Nurse |
ICU |
ICU Skin Saver team member |
Karen Ramnarine Williams, RN |
Clinical Nurse |
ICU |
ICU Skin Saver team member |
Mary Montejo BSN, RN, CWON, CWS |
Wound & Ostomy Coordinator |
Surgical Services |
Facilitator & Resource |
Leslie Everett BSN, RN, CCRN |
Patient Care Manager |
ICU/PCU |
Administrative Support |
OUTCOME(S)
Improvement in Patient Care Outcome
Exhibit SE4EOca: Percent of Patients with HAPU Stage II and Above, ICU
Analysis: Above graph shows that the ICU has achieved its goal of reducing the percent of patients with HAPU Stage II and above (patient care outcome) as evidenced by 3 data points below the baseline and national benchmark for 3 consecutive quarters post-intervention.
Summary Attachments/Hyperlinks/Evidences
Exhibit SE4EOca: Percent of Patients with HAPU Stage II and Above, ICU