Module 5: How To Measure Pressure Injury Rates and Prevention Practices
Slide Presentation
Slide 1: How To Measure Pressure Injury Rates and Prevention Practices
ADD Hospital Name Here
Module 5
Slide 2: Basic Quality Improvement Principle
If you can’t measure it, you can’t improve it.
Image: Puzzle pieces are labeled “assess readiness,” “manage change,” “implement practices,” “best practices,” “measure,” “sustain,” and “tools.” The piece labeled “measure” is highlighted in blue.
Slide 3: Quality Improvement Principle
- Pressure injury rates and prevention practices must be counted and tracked as one component of a quality improvement program.
Image: Photograph shows a medical provider writing and using laptop.
Slide 4: Module 5 Goals
- The Implementation Team will agree on and develop a plan for:
- Measuring pressure injury rates.
- Measuring pressure injury prevention practices.
- Communicating trends in pressure injury rates to key stakeholders.
Slide 5: Definition of Pressure Injury
- National and international (NPUAP-EPUAP) pressure injury definition:
Localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. The injury occurs as a result of intense and/or prolonged pressure, or pressure in combination with shear. - National Database of Nursing Quality Indicators (NDNQI) uses the same definition.
Slide 6: Pressure Injury Definition
- Do you use the NPUAP definition to measure and monitor pressure injuries?
- If not, what other definition would be appropriate for this hospital?
- Definition should be incorporated into:
- Policies and procedures.
- Root cause analyses/huddles.
- Staff education (definition and stages).
Slide 7: Pressure Injury Staging
- There are four stages of pressure injuries.
- The stages range from mild reddening of the skin to severe tissue damage that can become infected, extending into muscle and bone.
Slide 8: Stage 1
- Intact skin with nonblanchable redness of a localized area, usually over a bony prominence.
Image: Cross-section of Stage 1 pressure injury.
Source: National Pressure Ulcer Advisory Panel.
Slide 9: Stage 2
- Shallow open injury with a red-pink wound bed.
- No slough.
Image: Cross-section of Stage 2 pressure injury.
Source: National Pressure Ulcer Advisory Panel.
Slide 10: Stage 3
- Full-thickness tissue loss.
- Visible subcutaneous fat.
- No exposed bone, tendon, or muscle.
Image: Cross-section of Stage 3 pressure injury.
Source: National Pressure Ulcer Advisory Panel.
Slide 11: Stage 4
- Full-thickness tissue loss.
- Exposed bone, tendon, or muscle.
Image: Cross-section of Stage 4 pressure injury.
Source: National Pressure Ulcer Advisory Panel.
Slide 12: Unstageable
- Full-thickness skin and tissue loss in which the extent of tissue damage within the injury cannot be confirmed because it is obscured by slough or eschar.
- If slough or eschar is removed, a Stage 3 or 4 pressure injury will be revealed.
Image: Cross-section of unstageable pressure injury.
Source: National Pressure Ulcer Advisory Panel.
Slide 13: Deep Tissue Injury
- Persistent nonblanchable deep red, maroon, or purple discoloration.
Image: Cross-section of suspected deep tissue injury.
Source: National Pressure Ulcer Advisory Panel.
Slide 14: What Should Be Monitored?
- It is recommended that you regularly monitor:
- An outcome measure, preferably pressure injury incidence or prevalence rates.
- At least one or two care processes, such as skin assessment and pressure injury risk assessment.
- Key aspects of the infrastructure to support best care practices, such as clear lines of responsibility for overseeing the accuracy of skin assessments.
Slide 15: Measuring Pressure Injury Rates
Slide 16: Measure Only Pressure Injuries
- Many types of skin lesions may develop in hospitalized patients.
- Pressure injuries are areas of soft tissue damage caused by pressure or pressure and shear.
- Do not count skin lesions not related to pressure, such as skin breaks or maceration from friction/moisture.
- If not sure, ask the Wound Care Team or Nurse.
Slide 17: Measures
- Measures used in monitoring pressure injury rates:
- Incidence.
- Prevalence.
Slide 18: Incidence Rate
- Describes the number or percentage of patients developing a new pressure injury while in the hospital or on a particular unit.
- Provides the most direct evidence of the quality of your care.
- Should be the focus of your quality improvement efforts.
Slide 19: Prevalence Rate
- Prevalence rate describes the number or percentage of patients who have a pressure injury while in the hospital or unit.
- Point prevalence reflects a single point in time.
- Period prevalence reflects a prolonged period of time, such as an entire hospital stay.
- Point and period prevalence include injuries present on admission and new injuries that develop in your facility or unit.
Slide 20: Calculation Requirements
- Conduct a comprehensive skin assessment on every patient.
- Document the results of the assessment, noting:
- Presence of an injury.
- Number of injuries.
- Location of injuries.
- Stage of the deepest injury.
Slide 21: Common Methodology
- Monitor pressure injury rates:
- Choose a date.
- Have an outside expert perform a skin exam on each patient.
- Document the presence of each pressure injury:
- Stage of injury.
- New injury or present on admission.
- This process helps you determine incidence and prevalence rates.
Slide 22: Incidence Calculation
Monthly Unit Numbers | Example |
---|---|
# of patients who develop a new pressure injury after admission | 21 patients with a new pressure injury |
# of patients who develop a new >Stage 2 injury after admission | 5 patients with a new >Stage 2 pressure injury |
# of patients admitted during the month in question | 227 patients admitted |
# of patients with a new pressure injury divided by # of patients admitted | 21/227 = .093 5/227 = .022 |
Times 100 | .093 X 100 = 9.3% with an acquired pressure injury .022 X 100 = 2.2% with an acquired Stage 2 or greater pressure injury |
Slide 23: Prevalence Calculation
Monthly Unit Numbers | Example |
---|---|
# of patients with any pressure injury (count only patients, not the # of injuries) | 17 patients with any pressure injury |
# of patients with a >Stage 2 pressure injury | 5 patients with >Stage 2 pressure injury |
# of patients admitted during the month in question | 183 patients |
# of patients with a pressure injury divided by # of patients admitted during the month in question | 17/183 = .093 5/183 = .027 |
Times 100 | .093 X 100 = 9.3% with a pressure injury .027 X 100 = 2.7% with a Stage 2 or greater pressure injury |
Slide 24: Who Will Calculate Rates?
- When you complete your Action Plan, you will:
- Identify sources of data to complete.
- Select a person or team responsible for doing the calculations and tracking.
- Count the number and stage of pressure injuries in a month.
Image: Photograph shows two providers reviewing documents.
Slide 25: Stage 3 and 4 Injuries
- All pressure injuries are important to address.
- Yet Stage 3 and 4 injuries are very serious.
- Study what led to the occurrence.
- Usually when a deep pressure injury develops, it reflects a system failure.
- Conduct a root cause analysis.
Image: An icon of a magnifying glass in front of open book refers to Page 81.
Slide 26: Use of Data
- Examine the rates for trends over time:
- Graph the data to visually examine.
- Are the rates getting better or worse?
- Can you relate changes in rates to changes in practice?
- Rates are probably quite different by patient unit.
- Focus on trends over time. There will be fluctuations. Don’t overreact.
Slide 27: Displaying Data/Storytelling
- Run charts.
- Annotation: Show your interventions.
Slide 28: Annotated Run Chart Example
Intervention: Unit education, biweekly audits
Pilot Unit: ICU
Image: A line graph shows the number of pressure injuries, annotated with interventions.
Slide 29: Annotated Run Chart Example
Intervention: Annual education fair for all hospital staff and Shadowing Program in pilot units
Pilot Units: Med-Surg Unit and Critical Care Unit
Image: A line graph shows the number of Stage 2 or greater hospital-acquired pressure injuries per 1,000 patient days, annotated with interventions.
Slide 30: Annotated Run Chart Example
Images: Four line graphs chart the Percentage of Patients With Skin Assessment Within 24 Hours of Admission, before and after intervention, and Percentage of Patients with hospital-acquired pressure injuries (HAPIs) per 1,000 patient days, before and after intervention. A line between the before and after parts of the graph show when skin assessment training and monitoring compliance were initiated in pilot unit.
Slide 31: Painting the Picture With Data
- Data can tell you:
- Is your program improving?
- Are your patients safer?
Slide 32: Use of Data
- Find ways to disseminate the information to key stakeholders and unit staff.
- Post monthly rates where all staff can see how the unit is doing.
- Send reports to leadership.
Image: Photograph shows medical providers looking at papers.
Slide 33: Practice Insight
Visibility board shows:
- Immediate feedback each week.
- Best practice plans for improvement.
- Unit goal.
- Trended data.
Images: Icon of binoculars. Photograph of a visibility board.
Slide 34: Measuring Key Processes of Care
Slide 35: Measuring Prevention Practices
- Measuring pressure injury rates tells you how your facility is performing.
- Measuring pressure injury prevention practices may tell you how to improve care.
- If the pressure injury rate is high, what specific areas should you focus on?
- Are key practices to reduce pressure injuries being used consistently?
Slide 36: Which Prevention Practices Should Be Measured?
- Initially, look at three practices:
- Performance of comprehensive skin assessment within 24 hours of admission.
- Performance of standardized risk assessment within 24 hours of admission.
- Performance of care planning that addresses each risk factor identified during risk factor assessment.
Image: Photograph shows medical providers standing at a patient’s bedside.
Slide 37: Performance Review of Comprehensive Skin Assessment
- Ensure that a skin assessment was performed within 24 hours of admission.
- Use Tool 5C: Assessing Comprehensive Skin Assessment.
Images: A screenshot shows a sample comprehensive skin assessment. An icon of a magnifying glass in front of open book identifies this as Tool 5C.
Slide 38: Risk Factor Assessment Within 24 Hours
- Use the Braden Pressure Injury Scale (or the one this hospital agreed on).
- Ensure the known risk factors for pressure injuries are assessed.
- Tool 5D provides a sample protocol for assessing performance.
Slide 39: Risk Assessment Measurement Example
Images: A screenshot shows a sample standardized risk assessment. An icon of a magnifying glass in front of open book identifies this as Tool 5D.
If available, use data from your EHR to support calculation of this measure.
Slide 40: Assessment of Care Planning
- All the risk factors identified in the pressure injury risk factor assessment need to be addressed in the patient’s care plan.
- Act on the care plan:
- Use critical thinking.
- Tailor your approach to each patient, based on the patient’s risk factors.
- Ensure that the care plan addresses all areas of risk.
Slide 41: Care Plan Measurement Example
Images: A screenshot shows a sample care planning assessment. An icon of a magnifying glass in front of open book identifies this as Tool 5E.
Slide 42: Pressure Injury Prevention Practices
- Good performance on these key processes is critical to preventing pressure injuries.
- There is always an opportunity for improvement if you aren’t doing as well as you’d like.
- Examine what the problem is, and plan how to overcome this barrier.
Slide 43: Action Plan for Measuring Progress
Slide 44: Measurement Action Plan
Action Plan Tool To Measure Pressure Injury Rates and Prevention Practices
Measure Pressure Injury Rates | ||
---|---|---|
Key indicator | Who is responsible? | Completion date for plan |
Incidence and/or prevalence pressure injury rates are calculated. | ||
Pressure injury rates are monitored at least quarterly, and preferably monthly. | ||
Information on rates is disseminated to key stakeholders and staff. | ||
Root cause analysis is conducted for each >Stage 2 pressure injury. |
Measure Pressure Injury Prevention Practices | ||
---|---|---|
Key indicator | Who is responsible? | Completion date for plan |
Comprehensive skin assessment is performed accurately within 24 hours of admission. | ||
Pressure injury risk factor assessment is performed accurately within 24 hours of admission. | ||
Care plan addressing every deficit on pressure ulcer risk factor assessment has been developed and is being implemented. |
Slide 45: Action Plan
- Your Measurement Action Plan becomes Key Intervention 5.
Images: A sample Action Plan is shown with Key Intervention 5 circled in red. An icon of a magnifying glass in front of open book sits above the text "Refer to your Action Plan Template."
Slide 46: Summary of Accomplishments
- Discussed:
- Measuring pressure injury rates.
- Measuring pressure injury prevention practices.
- Communicating the trends in pressure injury rates to key stakeholders.
- Developed a Measurement Action Plan.
- Developed an overall Pressure Injury Prevention Program Action Plan.
Slide 47: Next Steps
- Over the next several weeks, we will meet weekly to refine your Action Plan for the Pressure Ulcer Prevention Program.
- Thank you for being part of this Team to make this hospital safer for patients.