【精品】《国家示范性高等职业院校建设计划 ..2

Partnering for the Prevention of Pressure Ulcers across the health care continuumSaratoga County Partners for the Prevention of Pressure Ulcers Wesley Health Care Center Saratoga Hospital Saratoga Care Nursing Home Maple wood Manor Saratoga Public Health Saratoga Community Hospice Schuyler Ridge Visiting Nurse Service of Saratoga and Schenectady CountiesSaratoga County Primary Provider Hospital Rehabilitation/Nursing Home HomeCounty Public HealthVisiting NursesHospiceOther Home Care ProvidersFocus : “War on the Sore” Improving pressure ulcer prevention and treatment in nursing homes has become a statewide priority. CMS has placed this challenge on hospitals through the 5 million lives campaign 10/08 was the date for hospitals to be in compliance with identifying pressure ulcers on admission in order to receive paymentCMS est. improving pressure ulcer care as national priority New York States overall nursing home pressure ulcer prevalence rate is 32nd in the nation New York States aggregate pressure ulcer prevalence rate of 9.1 percent is higher than the national goal of 5 percentDOH PROGRAM INTENT “Improving communication, coordination, and information transfer between providers when individuals move from one care setting to another”Pressure Ulcers F 314 “A resident who enters the facility without a pressure ulcer does not develop a pressure ulcer unless the individuals clinical condition demonstrates that they were unavoidable.”DOH PROGRAM INTENT “Improving consumer knowledge about pressure ulcer prevention and treatment”Why we started our meetings (12/06)To “ Partner for prevention” Share information and education Improve communication Provide cross-provider training on standards of practice Standardize data collection and reporting Focus on early detection of risk factorsPartnering for PrevenGoalGoaltioGpa;s”: Take the lead!Implement a standardized approach to “hand off” communicationsBlaming, finger pointing and territorialism is not conducive to quality care for the patient!Consider the prevention of pressure ulcers an organizational priority Focused on revised NPUAP definitions for staging Gave consideration to the Braden Plus (all care settings) Considered the use of technology when documenting and tracking Pressure Ulcers Introduced the use of ultrasound to detect deep tissue edema Invited participation at the monthly Saratoga meetings (sharing information from specialty units like the OR)Progress made to date Determine when risk for pressure first occurs Was the patient found on the floor at home? How long was this patient in the ER on a stretcher?How long was surgery and was there significant blood loss?Create a “look back” when screening for Admission to Long Term CareSaratoga Hospital Hospital Emergency Department Diagnostic Testing Operating Room Radiation Oncology Center (ROC) ICU General Unit Beds (D1, A3, C3) Care Management What steps need to be taken in the acute care? Identification of existing pressure ulcers on admission with accurate documentation and staging Risk assessments on admission and daily documentation Risk management (specialty beds, off loading pressure during surgery, better surface support in the ER) Improving communications between departments in the hospital and other providers Education of staff, patients and familiesSaratoga HospitalEmergency DepartmentLength of stretcher/wheelchair - surface time Delay until Admission: (2 to 6 hours) 22% admissions come through the ER Concerns with early identification of risk factors and prevention of pressure while in ER Present on Admission The cost of healing one pressure ulcer is estimated between $25,000 and $50,000 New level of priority with “POA” regulation from CMSSkin assessment needs to be completed by a “qualified trained individual” and documented on admission paper workThe ER physician may refer to the RN assessment note for this documentationA “bed hold” is considered an admission “Up coding” of the DRG will no longer be allowedSaratoga Hospital solutions for improvement Invite other providers to our monthly meetings Educate to the Braden Plus Increase Braden assessments Enc. representatives attend from all areas of the hospital (ER, ICU, and the OR) Consider the implementation of a TRACER MethodologyNDNQI Pressure Ulcer T/NDNQIPressureUlcerTraining/index.htmNPUAP: Suspected Deep Tissue Injury “Pressure related injury to subcutaneous tissue under intact skin” Goal: Detect edema under intact skin before damage is irreversibleScanning of the heelsEntering into the computerNormal AbnormalNormal compared to abnormal23Saratoga County Public HealthStandards of Wound CareJanuary 27, 200924Medicare PPS and Homecare The implementation of the Medicare Prospective Payment System (PPS) in 2000 presented several new challenges to home care agencies. Under this new system current wound care practices created a tremendous financial burden strain on resources within the home healthcare system. 25OASIS DATA As cited by the Remington Report, “According to current OASIS (Outcome and ASsessment Information Set) data, there will have been an estimated 7.7 million home care admissions in 2007. Nearly one-half million of those patients have pressure ulcers upon admission. “ Of the patients admitted to home care with a pressure ulcer, 79% have a stage 1 or 2 ulcer. A total of 20.6% have a stage 3 or 4 ulcer.26Home Care Challenges At the time of PPS implementation, a typical wound care order was “QD or BID wet to dry dressings.” This type of wound care consumed substantial nursing time, often resulted in lower patient outcomes, and had an adverse financial impact on home care agencies. 27Finding Solutions In 2003, Saratoga County Public Health joined forces with other local home care agencies to address these pressing issues. The goal of this group was to create standards of wound care that were followed by area home care agencies and consistently communicated to physicians offices and other referral sources. Objectives included: improved patient outcomes; decreased burden on home care staff; and reduce home car