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Perkins: We do a wrapup course at the end of our prevalence surveys and focus on themes. I’ m also lucky that we have our human factors team that performs some additional assessments focusing on those problem areas specific to pressure injuries. Was it work as imagined versus work in reality? Are they actually implementing the wedges? If not, what are the barriers to wedge use? Are they doing the Braden? Do they understand how to do a Braden correctly?
➠HSM: Can you tell us more about the human factors team?
Perkins: The human factors team members are not clinicians. They know a lot about healthcare, but that is not their expertise. But they’ re able to have really in-depth conversations with our bedside nurses with no judgment and understand if they are actually doing what we hope they are doing, and what does that look like, and then what are their recommendations for improving it?
Clinical Nurse Specialist: We recently had Medline do a Discovery Assessment to confirm some of what we thought was happening versus what is actually happening. And it was really eye-opening. One of the the proud points of that, though, is that 100 % of the staff they talked to knew their unit’ s prevalence numbers. So we’ re doing a good job of getting our information out to our staff and where we’ re having struggles.
➠HSM: What are some of those struggles?
Clinical Nurse Specialist: Storing some of the equipment that we’ re using for our pressure injury prevention initiatives has been a challenge. So, finding storage space is one of the things we wanted to highlight with that Discovery Assessment. Another thing I wanted to do is confirm our variation in care, and then take that information to the C-suite to say, we really need to standardize this work in some way. I don’ t want to take away everybody’ s options, but we have about five different kinds of soap and maybe three different ways to CHG bathe the patient, and I think
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standardization clears up some of the confusion that our staff have at the front line. We had a 21 % decrease in HAPIs over last year, so we’ re moving in the right direction, for sure. But now it’ s really time to focus on the less low hanging fruit and find those focused areas.
➠HSM: What has been some low hanging fruit for you?
Clinical Nurse Specialist: When I got into place, the only education that our skin champions was given was the NDNQI modules. They did not feel like they were prepared to lead that work at the bedside. So we instituted monthly education sessions for them, and we also did a sort of Lean process with them, but I don’ t like them to know that’ s what we’ re doing. So we sneak in questions like,‘ What is your practice? What are the gaps? What are your challenges? What things are you celebrating with your staff?’ Like a gap analysis without it being that formal. It’ s more of a conversation, and people feel comfortable sharing. And then we were able to put that into a document and present it to the leadership where we needed support both financially and from staffing.
HSM: What about different kinds of education to help the staff be aware of pressure injuries on all skin tones?
Johnston: We were able to get wound models in both dark and light skin tones for the units. And we’ re trying to provide additional information on photos about what wounds look like on dark skin or what you can look for. But I definitely think that’ s a difficult education lift for people because we’ re already struggling to get that education out.
Clinical Nurse Specialist: We landed on thermography, because with our darker pigmented patients, it’ s often not until a deep tissue injury has formed and that top layer of skin has come off that staff can see blatant pink or red and recognize that that’ s what it is. So we’ re hoping that the thermal imaging will do better. We’ ve thought about a sub epidermal moisture scanner, but it’ s based on multiple scans over multiple days to really give you a good delta.
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“ 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?”— Ashley Perkins, clinical nurse specialist, Corewell
Health, Grand Rapids, Mich.
➠HSM: What are some ways you’ ve celebrated the wins?
Perkins: We’ ve done what we call fun rounding, really highlighting what they’ ve done well. We just did one that we called“ HAPI hour,” and we served non-alcoholic margaritas to our nurses on our cardiac progressive unit and our MICU to celebrate their HAPI reduction while they were piloting some technology for us.
On Worldwide Pressure Injury Prevention Day, we did some intentional rounding and wore peach costumes, passed out peach stickers and had peach cookies for the skin champions. Really focusing on keeping the conversation going, keeping the engagement there, hearing feedback from the nurses on what ' s going well and what ' s not, and reminding them that these are focused problems that we want to continue to work through together. And we brought a smile to their faces with our peach costumes. ◼
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