medical device-related? Is it turning surfaces?— That gives them ownership of the outcomes, and they see that improvement month to month.
➠HSM: Can you give us an example of a creative approach?
Perkins: One unit was focusing on bathing, and they had a month-long competition with each other where they intentionally focused on bathing every patient every day, using rubber duckies to sign off that the patient was bathed. We know documentation is always an opportunity, but this was a way for them to have that visual cue to show,‘ OK, we have achieved this on X number of patients today.’
Teresa Johnston, clinical outcomes manager with quality, Ohio Health, Grant Medical Center: I worked on the floor and then wound care and then moved to quality. And so sometimes I have a unique perspective in that I feel like the units forget about a quality person, and how we can track trends and help them with those things. So from a system perspective, we implemented a four eyes skin assessment and made some tweaks to Epic so we can be a little more accountable on that.
We’ re also using skin champions and encouraging them to use the Braden Scale, because we want them to understand they need to pair those pieces, that it’ s more than just what you’ re visually seeing. And then we share this at a system HAPI group where we can show how we’ re linking what the system’ s goals are and what we’ re doing at our individual units’ HAPI meetings.
I think it’ s definitely interesting to figure out how all those meetings and pieces go together. But it can be a challenge to get back down to that granular unit level and individual nurse. What are you capable of? What are your understandings and your gaps?
“ Our bedside nurses often come up with creative ideas based on what they’ re seeing as their trends in HAPIs.”
— Ashley Perkins, clinical nurse specialist, Corewell
Health, Grand Rapids, Mich.
➠HSM: Do any others have skin health advocates? How has that impacted outcomes at the bedside over time?
Midwest-based Clinical Nurse Specialist: We use the champion model here, and I’ m aware of every pressure injury we have institutionally, and we do track trends. We have unit-based clinical nurse specialists that review every pressure injury and then report back to the pressure injury committee on what they found, whether our standard of care was met or not, and what contributing factors existed. Our skin champions participate in our prevalence study and are given time to enter their data into our online data collection system and then attend education specific to what trends we’ re seeing.
Our skin champions also complete NPIAP modules for pressure injuries and are part of our focus group for writing and updating our policies and bringing forward suggestions for initiatives. We really lean into those frontline staff who are their unit-based resource for all things pressure injury prevention.
Trisha Conn, WCC, Ohio Health, Berger Hospital, Circleville, Ohio: We don’ t have any responsibilities for skin champions outside of participating in the quarterly prevalence. Definitely something that we need to invest some time in. I think with Berger being a smaller hospital and having one inpatient nurse, most days, I can manage it, and I’ m very visible to all of the staff. We have also implemented the four eyes assessment, and we have Rovers that are taking photos of every single wound.
➠HSM: What strategies have been the most effective for educating on PI prevention? Any creative ways that have really worked best?
Conn: Hands-on education has been the most effective here. If I’ m noticing something and ask the nurse managers to put that in the huddle, they’ ll do that every shift change. So that’ s nice because it’ s coming from management and not just me. When I’ m seeing patients, the nurses are engaged in what I’ m doing. They’ ll come into the room with me. They want to watch me do what I’ m doing. And so as I’ m doing it, I’ m having that lowkey conversation with them, like,‘ OK, it ' s good that you placed the wedges, but maybe let ' s put them so that the sacrum is offloaded.’
Perkins: I absolutely echo what Trisha said about the wedges. Wedge placement is complex. Nurses have to spend so much time and effort to turn a patient, and the little amount of time that’ s ever focused on education to turn a patient is really inadequate. We’ ve done a lot of skills reviews and skills fairs focusing on problem areas like offloading and external urinary devices, things that we’ ve seen impact with around pressure injuries. It’ s great when you focus on it, but as soon as you take away that focus, you see the problem arise again. So that sustainability piece is quite complex.
➠HSM: Do you communicate the prevalence data to the frontline staff? And if so, how does that help?