Module 1: Preventing Pressure Injuries in Hospitals—Understanding Why Change Is Needed

Slide Presentation

Slide 1: Preventing Pressure Injuries in Hospitals

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ADD Name of Hospital Here

Module 1–Understanding Why Change Is Needed

Image: Cover of Preventing Pressure Ulcers in Hospitals Toolkit.

Slide 2: Ice Breaker

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  • Describe an interesting fact about yourself.

Image: Photograph shows a goldfish jumping from one fishbowl to another to join other goldfish.

Slide 3: Compelling Reasons To Implement Program

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  • Pressure injury rates continue to escalate.
    • The incidence of pressure injuries increased by 80% from 1995 to 2008.
    • Every year, 2.5 million patients develop a pressure injury.
    • Because of the ever-increasing number of obese, diabetic, and elderly patients, rates are predicted to continue to rise.

Slide 4: Compelling Reasons To Implement Program

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  • Pressure injuries increase costs.
    • Pressure injury treatment costs as much as $11 billion each year.
    • Individual patient care costs $20,900 to $151,700 per pressure injury.
    • Patients with pressure injuries need more care.
    • Longer inpatient stays often result.
  • Since 2008, CMS no longer allows higher diagnosis-related group (DRG) payments for patients with >Stage 2 pressure injuries.
  • Most pressure injuries are preventable.

Source: Centers for Medicare & Medicaid Services, 2008

Slide 5: Practice Insight

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Approximate Cost of HAPI—Stage 3, 4, Unstageable, and DTI

Images: Two tables show Hospital-Acquired Pressure Injuries (HAPI), January–June 2015 and Hospital-Acquired Pressure Injuries, January–December 2014 respectively. The Total row at the bottom of each table is circled in red, showing that # HAPI and ~Cost have lowered from 27 HAPI and $1,165,860 in 2014 to 16 HAPI and $690,880 in 2015.

Slide 6: Prevention Works

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  • Multicomponent prevention programs reduce pressure injury rates.
    • Systematic reviews show that pressure injury prevention programs result in statistically and clinically significant reductions in pressure injury rates.
    • Rates can drop 50% to 100%.
    • Other benefits include optimal patient care and avoiding the cost of treating Stage 3 and above injuries.

Source:  Sullivan, 2013,

Slide 7: Are You Ready for This Change?

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  • Introductory Executive Summary for Stakeholders. (Tool 0A)
  • Stakeholder Analysis. (Tool 1B)
  • Does senior leadership support this initiative? (Tools 1C, 1D)
  • Who will take ownership of this effort?
  • What resources are needed? (Tool 1E)

Slide 8: Practice Insight

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Value of Pre-Assessment Tools

Image: An array of tools is shown: Tools 1D, 1E, 2A, and Pressure Ulcer Policy Assessment. Icon of binoculars.

Slide 9: Training Objectives

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  • Educate hospital leadership and Implementation Team on the Preventing Pressure Ulcers in Hospitals Toolkit to facilitate the change process in hospitals.
  • Develop hospital-specific action plans for implementing a Pressure Injury Prevention Program using the Toolkit.
  • Address the specific challenges of preventing pressure injuries in the hospital.
  • Use and adapt the tools and resources to implement the Pressure Injury Prevention Program.

Slide 10: Today’s Group Dynamics

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  • Your Implementation Team Leader (or the designee) will present current assessments of your hospital’s procedures and policies.
  • Everyone here plays an important role.
    • We encourage all to participate in planning activities.

Slide 11: Today’s Group Dynamics

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  • “Parking lot” to capture your ideas:
    • We’ll try to address your comments, but we may need to address them later during the Implementation Phase.
  • Much ground to cover today

Slide 12: Implementation Training

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The Toolkit focuses on:

  • Reducing pressure injuries during a patient’s hospital stay.
  • Successfully negotiating the change process at your hospital.

Image: Puzzle pieces are labeled “assess readiness,” “manage change,” “implement practices,” “best practices,” “measure,” “sustain,” and “tools.”

Slide 13: Preventing Pressure Ulcers in Hospitals Toolkit

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Toolkit Sections:

  1. Is your hospital ready for this change?
  2. How will you manage change?
  3. What best practices in pressure injury prevention do you want to use?
  4. How do you implement these best practices in your organization?
  5. How do you measure pressure injury rates and pressure injury prevention practices?
  6. How do you sustain an effective Pressure Injury Prevention Program?

Image: Cover of Preventing Pressure Ulcers in Hospitals Toolkit.

Slide 14: Toolkit Approach

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  • The Toolkit focuses on an interdisciplinary approach.
    • This approach pulls staff members from many areas with needed expertise to address the problem.
    • Pressure injury prevention requires active engagement of multiple disciplines and teams that care for the patient.

No clinician working alone can prevent pressure injuries.

Image: Photograph shows medical providers standing behind a seated patient.

Slide 15: Toolkit Approach

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  • The Toolkit includes accurate, evidence-based, and effective risk assessments that call for:
    • Critical thinking and clinical judgment—not just memorizing how to conduct assessments.
    • Consistency in approach.
    • Risk identification and communication at the earliest possible time.

Slide 16: Toolkit Approach

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  • The Toolkit focuses on optimizing effectiveness of interventions by:
    • Tailoring interventions to address individual risk factors.
    • Assessing their effectiveness.
    • Modifying interventions as appropriate.

Image: Photograph shows medical provider with patient.

Slide 17: Sustainment

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“Holding the gains and evolving as required, definitely not going back to the old way.”

Source:  Maher L, 2013; Maher L, 2012.

Image: Photograph of a tree.

Slide 18: When Should We Worry About Sustaining the Gains?

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  • Actions to ensure sustainability must start at the beginning of a project.
  • If you leave it to the end, it will be too late to make any changes that are needed to maximize the potential of sustainability.

It is very important to ensure you have things in place from the beginning to achieve and sustain the best improvement outcome you can.

Slide 19: Steps to Sustainability

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Your Journey

Managing Change Checklist

Implementation Team composition:

  1. ___ Team Leader has been identified and is in place.
  2. ___ Sustain: Changes need to become so integrated into existing organizational structures and routines that they are no longer noticed as separate from business as usual.Members with necessary expertise/role have been identified/invited.
  3. ___ Linkage to senior leadership has been defined and established.

Team startup:

  1. ___ Team agenda and charge are clearly stated.
  2. ___ Team has necessary training and resources to get started.

Current state of fall prevention practice and knowledge:

  1. ___ Current practice and policies have been systematically examined.
  2. ___ Challenges to good practice have been identified at organization and unit levels.
  3. ___ Staff knowledge has been assessed.

Starting the work of redesign:

  1. ___ Approaches to redesign have been explored and chosen.
  2. ___ Gap analysis has been conducted between current practice and recommended practice.

Setting goals and plans for change:

  1. ___ Specific goals have been set.
  2. ___ A plan for making changes to meet those goals has been initiated.
  3. ___ A preliminary plan for sustaining the changes is in place.

Source: AHRQ Preventing Pressure Ulcers in Hospitals Toolkit.

Image: Puzzle pieces are labeled “assess readiness,” “manage change,” “implement practices,” “best practices,” “measure,” “sustain,” and “tools.”

Slide 20: Sustaining Change

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  • Sustain: Changes need to become so integrated into existing organizational structures and routines that they are no longer noticed as separate from business as usual.

Image: Puzzle pieces are labeled “assess readiness,” “manage change,” “implement practices,” “best practices,” “measure,” “sustain,” and “tools.” The piece labeled "sustain" is highlighted in blue.

Slide 21: High-Reliability Organizations

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  • High-reliability organizations:
    • Provide consistent performance at high levels of safety over long periods of time.
    • Practice “collective mindfulness,” understanding that even small failures in safety protocols or processes can lead to catastrophic or adverse events if action is not taken to solve the problem.
    • Eliminate deficiencies in safety processes through the use of powerful tools to improve their processes.
    • Create an organizational culture that focuses on safety; they are constantly aware of the possibility of failure.

Source: Chassin MR, Loeb JM, 2013; Chassin MR, Loeb JM, 2011.

Slide 22: Components of Sustainability

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Four key strategies:

  1. Engage Leadership.
  2. Measure Continuously/Evaluate for Change.
  3. Collaborate With All Disciplines.
  4. Hardwire Practices and Educate.

Slide 23: Leadership Support

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  • High-level senior leadership buy-in.
  • Designated pressure injury prevention Implementation Team Leader.
  • Designated pressure injury prevention Implementation Committee/Interdisciplinary Team.

Image: Photograph shows leaders and medical providers meeting at a table.

Slide 24: Engage Leaders

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It is the right thing to do—patient stories, their stories.

  • WIFM: What’s in it for me/them?
    • Cost avoidance estimation
    • Patient throughput
    • Turnover reduction
  • Leaders: Aligning improvement efforts and organizational priorities
  • Senior executives: Sharing prevention plans (project charter), communicating needs and progress

Source: Duval-Arnould J, Mathews SC, Weeks K, et al., 2012; Waters HR, Korn R Jr, Colantuoni E, et al., 2011

Slide 25: Practice Insight

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Project Charter: Multidisciplinary Pressure Ulcer Prevention Program
Key Stakeholders: WOC, Nursing Staff, Physical Therapy, Nutrition

Image: Icon of binoculars. Four panels show the Project Definition, the Critical Success Factors, the SharePoint Site and the Implementation Team. An apple icon is used in the last two panels.

Slide 26: Engage Leaders

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  • Leadership support:
    • Seek vice president or higher.
    • Engage support for team’s work.
    • Rounding on unit—be purposeful.
      • Script the rounds.
        • How will the next patient in this unit be harmed?
        • How can I help to remove barriers so that the safety defects we are most concerned about can be better addressed?
        • How well does teamwork occur on this unit?
        • What doesn’t work well?
      • Use learning board as unit’s meeting point.

Source: Sexton JB, 2010.

Slide 27: Practice Insight

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Engage Leaders in Rounding on Units

Image: Photograph shows medical providers and family member at a patient's bedside.  Icon of binoculars.

Slide 28: Components of Sustainability

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Four key strategies:

  1. Engage Leadership.
  2. Measure Continuously/Evaluate for Change:
    • Harness the power of local data to drive improvement efforts.
    • Track prevention practices.
    • Learn from defects.
  3. Collaborate With All Disciplines.
  4. Hardwire Practices and Educate.

Slide 29: Using Data for Continued Improvement

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  • Continue to collect process and outcome data.
  • Set targets for process and outcome data.
  • Gather information from defects.
  • Use the data to identify opportunities and hardwire practices.
  • Share data with:
    • Improvement Team.
    • Frontline staff.
    • Leadership.

Slide 30: Purpose of Measurement

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  • Measuring pressure injury prevalence and incidence rates and looking at prevention practices tells you:
    • If any areas of care can be improved.
    • If you are meeting your aims.
    • If practice changes improve incidence.
    • If you are sustaining improvements.

If you don’t know where you are, how do you know if you are improving?

Slide 31: Examining Processes To Understand Outcomes (Example)

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Images: Four line graphs show Percentage of Patients With Skin Assessment Within 24 Hours of Admission, Before intervention and After intervention; and HAPUs/1,000 patient days, Before intervention and After intervention. A line between the before and after sections shows when skin assessment training and compliance monitoring were initiated in Pilot Unit.

Slide 32: Components of Sustainability

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Four key strategies:

  1. Engage Leadership.
  2. Measure Continuously/Evaluate for Change.
  3. Collaborate With All Disciplines:
    • Collaborate with multiple disciplines.
    • Identify physician and nurse champions.
    • Tap into the wisdom of frontline staff.
  4. Hardwire Practices and Educate.

Slide 33: Power of Collaboration

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  • Senior leadership support is important, but change comes most effectively from frontline staff. Tap into their wisdom.
  • Multidisciplinary collaboration is essential to carrying out pressure injury prevention.
  • Gaining buy-in from all involved results in shared ownership of positive prevention results.

Image: Photograph shows leaders and medical providers meeting at a table.

Slide 34: Sustainable Collaboration

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  • The pressure injury prevention group should:
    • Continue to meet (or merge with an existing group).
    • Report up through a quality structure.
    • Have a vision with clearly defined goals and an associated action plan. (Update every 6-12 months.)
  • The Team and its goals should be:
    • Aligned with its organization’s goals of preventing harm.
    • Part of the dashboard.

Slide 35: Collaborative Relationships

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Image: A Venn Diagram consists of three overlapping circles captioned:

  • Implementation Team: Large interdisciplinary team charged with designing and implementing pressure ulcer change project.
  • Wound Care Team: Interdisciplinary group of experts who provide day-to-day care of skin and wound needs.
  • Unit-Based Team: Staff on the unit who provide daily care to patients, which includes skin and pressure ulcer assessment as part of all aspects of patient care needs

The area where the circles overlap is captioned "Unit Champion (liaison between teams for individual units)".

Slide 36: Components of Sustainability

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Four key strategies:

  1. Engage Leadership
  2. Measure Continuously/Evaluate for Change
  3. Collaborate With All Disciplines
  4. Hardwire Practices and Educate:
    • Standardize care: prevention practices.
    • Include practices in patients’ daily goals.
    • Train new staff in evidence-based prevention practices.

Slide 37: Resource Needs Assessment

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  • Your Implementation Team Leader filled out the Resource Needs Assessment (Tool 1E) with support from your hospital supervisors, managers, and administrators.
    • This checklist helps identify needed resources:
      • Funds.
      • Staffing needs.
      • Information technology support.
      • Products/tools.

Images: Icon of a magnifying glass in front of an open book; checklist from Tool 1E: Resource Needs Assessment.

Slide 38: Resource Needs Assessment

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  • Team Leaders: Let’s share results of this assessment for your organization.

Slide 39: Team Charge

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  • Implement a Pressure Injury Prevention Program within 8-10 months.

Slide 40: References

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Page last reviewed October 2017
Page originally created September 2017
Internet Citation: Module 1: Preventing Pressure Injuries in Hospitals—Understanding Why Change Is Needed. Content last reviewed October 2017. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/professionals/systems/hospital/pressureinjurypxtraining/workshop/module1/mod1-slides.html
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