Module 3: Best Practices in Pressure Injury Prevention
Slide Presentation
Slide 1: Best Practices in Pressure Injury Prevention
ADD Hospital Name
Module 3
Slide 2: Best Practices
- Best practices are those care processes—based on literature and expert opinion—that represent the best ways we currently know of preventing pressure injuries in the hospital.
- AHRQ Patient Safety Network (PSNET)
https://psnet.ahrq.gov/
Image: Puzzle pieces are labeled “assess readiness,” “manage change,” “implement practices,” “best practices,” “measure,” “sustain,” and “tools.” The piece labeled “best practices” is highlighted in blue.
Slide 3: Module 3 Goals
- Identify opportunities for improvement:
- Which pressure injury prevention practices to use.
- How to perform a comprehensive skin assessment.
- How to conduct a standardized assessment of pressure injury risk factors.
- How to incorporate risk factors into care planning.
Note: At various points during the module, we’ll discuss which best practices you want to include in your prevention program.
Slide 4: Bundle of Best Practices
- Pressure injury prevention practices checklist:
- ___ Comprehensive skin assessment.
- ___ Standardized pressure injury risk assessment.
- ___ Care planning and implementation to address areas of risk.
Slide 5: Best Practice
Comprehensive Skin Assessment
Slide 6: Comprehensive Skin Assessment
- Examine the entire skin (from head to toe) for abnormalities.
Images: Two overlapping screenshots show Elements of a Comprehensive Skin Assessment. An icon of a magnifying glass in front of open book identifies this as Tool 3B.
Slide 7: How To Do a Skin Assessment
Video Clip of Skin Assessment
Image: Icon of a blank movie-projection screen.
Slide 8: Skin Assessment Frequency
- Not a one-time event.
- Repeated on a regular basis.
- Optimally done daily in a systematic manner by a single individual at a dedicated time.
- May be integrated into routine care—any time the patient is cleaned or turned.
Image: Photograph shows a medical provider examining a patient's head.
Slide 9: Medical Device Skin Assessment
Image: A screenshot shows a checklist card titled "Best practices for prevention of medical device-related pressure ulcers."
Slide 10: Reporting and Documenting
- Skin assessment results must be documented in the medical record. Then staff must be made aware of the assessment.
Image: Photograph shows medical providers consulting a tablet.
Slide 11: Barriers to Practice
- Finding time for skin assessments.
- Determining correct etiology of wounds.
- Using inadequate documentation forms.
- Lacking ways to empower staff to report abnormal skin findings:
- Consider using Tool 3C: Pressure Ulcer Identification Pocket Pad.
Slide 12: ID Pocket Pad
Images: The Pressure Ulcer Identification Pocket Pad is shown. An icon of a magnifying glass in front of open book identifies this as Tool 3C.
Slide 13: Practice Insight
Images: Icon of binoculars. A screenshot shows the annotated body image for admission documentation; on the screenshot are the following notes and instructIons: "Complete within first 24 hours of admission"; "Cosign required"; "If pressure injury is POA, make sure that document is sent to be cosigned by the medical provider"; "Annotated image needs to be completed on all admissions even if no skin disruption is found. Or note location if skin disruption noted".
Slide 14: Improving Assessment Practice
- Ask a colleague to confirm skin assessment.
- Perform skin assessment with an expert.
- Ask for clarification.
- Use available resources.
- See tips for making assessments part of the routine.
Image: An icon of a magnifying glass in front of open book refers to Page 42.
Slide 15: Best Practice
Pressure Injury Risk Assessment
Slide 16: Pressure Injury Risk Assessment
- Next step in prevention.
- Goal: to identify patients at risk.
Image: Photograph shows a medical provider at a patient’s bedside, examining the patient's legs.
Slide 17: Risk Assessment Scales
- Only one part of risk assessment.
- Meant to be used in conjunction with a review of other risk factors and clinical judgment.
- More factors to consider.
- Especially helpful in identifying patients at mild to moderate risk.
- Two widely used scales:
- Braden Scale (Tool 3D).
- Norton Scale (Tool 3E).
Image: An icon of a magnifying glass in front of open book refers to Page 44.
Slide 18: Braden Scale
- Six subscales, scored from 1-4 or 1-3:
- Sensory perception.
- Moisture.
- Activity.
- Mobility.
- Nutrition.
- Friction/shear.
Image: Photograph shows a medical provider with a patient in a wheelchair.
Slide 19: Risk Assessment Case Study—Mr. K
Image: Photograph shows a patient lying in bed.
Slide 20: Braden Scale—Mr. K
Image: A screenshot shows a sample Braden Pressure Ulcer Risk Assessment scale filled out for Mr. K's case.
Slide 21: How Often?
- Recommendations vary.
- In general acute care settings, do risk assessment upon admission, then daily or with a significant change in condition.
- In critical care settings, frequent assessments should be done, such as at every shift.
- For risk assessment in pediatrics.
Image: An icon of a magnifying glass in front of open book refers to Page 46.
Slide 22: Documentation
- Have computerized (or paper) form in medical record.
- Incorporate results in daily patient flowsheet.
- Include results in patient report or handover.
Slide 23: Next Steps
- Knowing which patients are at risk is not enough; you must also do something about it.
- Care planning guides what will be done to prevent pressure injuries.
Image: Photograph shows medical providers holding a meeting in a hospital corridor.
Slide 24: Best Practice
Pressure Injury Care Planning
Slide 25: Care Planning
- A process to transfer the patient’s risk assessment information into an action plan to address his or her needs:
- Implement care practices so that your patient does not develop a pressure injury.
- Develop a care plan for any area of risk.
- Tailor the plan to fit the patient’s needs.
- Modify as needed to capture your patient’s response to interventions and any changes in condition.
Slide 26: Patient and Family Education
Images: Two screenshots show a patient brochure titled "Help Us Protect Your Skin". An icon of a magnifying glass in front of open book identifies this brochure as Tool 3G.
Updated brochure available at: http://www.njha.com/media/43477/puconsumereng.pdf
Slide 27: Sample Care Plan
Images: Two screenshots show a sample care plan. An icon of a magnifying glass in front of open book identifies this care plan as Tool 3F.
Slide 28: Practice Insight
EHR Care Plans Triggered Based on Risk Assessment
Braden Scale for Predicting Pressure Sore Risk
SENSORY PERCEPTION | 1. Completely Limited | 2. Very Limited | 3. Slightly Limited | 4. No Impairment |
---|---|---|---|---|
MOISTURE | 1. Constantly Moist | 2. Very Moist | 3. Occasionally Moist | 4. Rarely Moist |
ACTIVITY | 1. Bedfast | 2. Chairfast | 3. Walks Occasionally | 4. Walks Frequently |
MOBILITY | 1. Completely Immobile | 2. Very Limited | 3. Slightly Limited | 4. No Limitation |
NUTRITION | 1. Very Poor | 2. Probably Inadequate | 3. Adequate | 4. Excellent |
FRICTION & SHEAR | 1. Problem | 2. Potential Problem | 3. No Apparent Problem | |
Total Score |
© Barbara Braden and Nancy Bergstrom, 1988. Used with permission.
Images: Icon of binoculars. A series of arrows pointing to the right in six rows depict the following process:
Sensory Perception → Less than 3 → Sensory Perception Care Plan Triggered
Moisture → Less than 4 → Moisture Care Plan Triggered
Activity → Less than 3 → Activity Care Plan Triggered
Mobility → Less than 3 → Mobility Care Plan Triggered
Nutrition → Less than 3 → Nutrition Care Plan Triggered
Friction & Shear → Less than 3 → Friction & Shear Care Plan Triggered
Slide 29: Improve Care Planning
- Ensure that staff appreciate the value of care planning.
- Let staff know their roles and responsibilities in reducing pressure injury incidence.
- Empower staff to carry out their roles.
Image: Photograph shows medical providers looking at a wall-mounted computer monitor.
Slide 30: Improve Care Planning
- Make care planning more streamlined—link to the assessment task.
- Document using the computer to tie the assessment directly to the care plan (saves time).
- Use prompts to update the plan as your patient’s condition changes (helps ensure his or her needs will continue to be met).
Image: Photograph shows medical providers looking at a tablet.
Slide 31: Improve Care Planning
- Examples of prompts linked to routine practice:
- Generate a reminder to conduct pressure injury risk assessment when a patient is in the OR for more than 4 hours.
- Order support surfaces and skin care products for patients you identify as at risk.
- Include the care plan in shift reports and patient handoffs.
Remember: Let all levels of staff know what is required daily so they automatically carry out the task.
Slide 32: Identify Your Bundle of Best Practices
Slide 33: Identify Best Practices
- Comprehensive skin assessment.
- Standardized risk assessment:
- Norton? Braden? Waterlow?
- Another validated scale?
- Care planning.
Slide 34: Identify Best Practices
- Comprehensive skin assessment:
- Would you recommend that each admitted patient receive a skin assessment?
- When would you recommend it get done again, if needed?
- How do you want the assessment to be conducted?
Slide 35: Identify Best Practices
- Risk assessment:
- Which standardized risk assessment scale do you plan to use?
- When do you plan to complete risk assessments?
Slide 36: Identify Best Practices
- Care plan:
- Does your current pressure injury planning process suffice for your prevention program?
- Or should it be revised? If so, who will revise it? Care plan:
- Does your current pressure injury planning process suffice for your prevention program?
- Or should it be revised? If so, who will revise it?
Slide 37: Best Practices
- Need to be customized:
- Each patient has a different set of pressure injury risk factors, so care must address each patient’s unique needs.
Slide 38: Practice Insight
Images: Icon of binoculars. A screenshot shows the Pressure Ulcer Prevention Program Action Plan: June 2015-January 2016. Key Intervention 2 is circled in red.
Slide 39: Action Plan
- Discuss action steps for Key Intervention 2.
- Determine who is responsible for this task and when it will be completed.
Images: A sample Action Plan is shown with Key Intervention 2 circled in red. An icon of a magnifying glass in front of open book sits beside the text "Refer to your Action Plan Template."
Slide 40: Summary
- We reviewed:
- Comprehensive skin assessment.
- Braden and Norton risk assessment tools.
- Care planning.
- You identified best practices for your hospital.
- You completed Key Intervention 2 of the Action Plan.