Skin issues that develop within healthcare facilities pose a preventable yet reoccurring problem.
In an effort to promote and encourage the development of skin safety programs to decrease the prevalence of skin issues within health facilities, the Wound, Ostomy, and Continence Nurses (WOCN) Society began partnering with 3M Critical & Chronic Care Solutions Division in 2012 to offer an annual 3M Award for Excellence in Skin Safety. The award recognizes WOCN Society members or teams creating and sustaining a skin damage prevention program that demonstrates positive clinical outcomes, teamwork, and knowledge transfer. To learn more about one winner’s journey, view this video.
With the 2016 3M Award for Excellence in Skin Safety now accepting submissions (deadline is March 11), three previous winners share the strategy and goal behind their specific skin safety program, why they felt they stood out as winning programs, updates since they were awarded, and advice they’d give other facilities looking to develop their own skin safety program.
Cancer Treatment Centers of America
Why do you feel you were selected to receive the 3M Award for Excellence in Skin Safety? What made your organization stand out? In 2011, we knew we had a quality improvement project to improve hospital-acquired pressure ulcers. We not only had the data but audit tools were already being utilized. We believe the follow-through made us stand out – we have a committed team and good numbers to show for it. Not only was there a significant improvement in patient outcomes, but reduction in pressure ulcers that show we have a comprehensive program. From start to finish, there is support from administration, stakeholders (employees), and nurses to carry the program out 24/7. The commitment goes beyond wound care nurses as there are tools in place for unit nurses as well. We are always looking to improve the direction of the team and where it is going.
Describe your facility’s approach to preventing and treating incontinence-associated dermatitis (IAD)For prevention, we currently use a skin regimen in place in the hospital. The process consists of two steps – cleansing with foam cleanser followed by lotion or skin barrier. We also utilize absorbent moisture pads on the bed, as well as the use of low air loss mattresses.
Describe your facility’s approach to preventing and treating pressure ulcers. When it comes to prevention, we have inclusion criteria for high-risk patients to implement devices to prevent pressure ulcers. These include low air loss mattresses, a turning system, a seated positioning system, turning schedules, and preventive foam dressings.
As for treating, we have policies and posters for all units to show staff how to appropriately identify ulcers as well as how to choose the best treatment option. All supplies are readily available in the dispensing system and all pressure ulcers are consulted to wound care within the hospital.
What investments were necessary (e.g., financial, educational, technical, resources, leadership/management support, etc.) to implement your skin care program?
Management has been generous with ensuring that staffing is adequate, and has allowed the wound care team to attend biannual training, as well as monthly prevalence for all nurses. Prior to development of the skin team, there was general education for nurses, but not a comprehensive program.
Additional advance education is provided to the skin team (30 nurses). If administration hadn’t supported the program, it wouldn’t have happened, let alone become a success. Leadership from the chief nursing officer down through nursing supervisors are very supportive.
Have any of your skin care protocols been updated or changed since you won the 3M award? If so, which ones?
Nothing has been changed, but we are trying to implement additional measures in the OR, different offloading devices and improving audit tools. We are becoming more nurse-driven and patient-driven; we want nurses to feel empowered to take care of ulcers.
How do you measure skin health outcomes? What have been your greatest successes in this area? Your greatest challenges?
Nurses do 12-hour skin assessments for inpatients, and there are weekly wound care rounds on “Wound Care Wednesday.” Monthly prevalence is another measure taken to make the program a success.
For those with individualized wounds, we use objective (nurse) and subjective(patient) data. The incidence of pressure ulcers in 2014 was 1.025 percent, down from a previous low of 3 percent, and a previous high of 11 percent. Our greatest challenge is that the oncology patient population, due to malnutrition, low mobility, comorbidity, and poor wound healing due to chemo and disease, is at a higher risk for non-healing wounds.
How have you earned staff buy-in across functions for patient skin health prevention and care?
We have implemented simple, straightforward policies supported by best practices – we gave the staff strict options. Not only did we simplify policies and procedures, we made tools available to staff to implement early interventions in order to optimize patient care and outcomes.
Those that participate in the SWOT team have the ability to add to their clinical ladder, which does carry a financial incentive. The SWOT team is now streamlined, with clear expectations and goals, which motivates our team.
What is your top piece of advice for other organizations looking to improve upon their skin safety best practices?
Identify your patient population – is the hospital community-based? Each unit has different needs, what is their risk? Be transparent with strengths and weaknesses, as well as ulcer rates. Praise and acknowledgement of staff efforts and accomplishments are important, as is an understanding that developing a successful program is “a journey, not a destination.” Continuously look at improving your skin safety program.
Initially, you need to have a foundation of education provided to all staff and a thorough assessment of your organization’s strengths and deficits. Simplify and streamline protocols and procedures, and make tools available for staff (dressings, lotions, turning devices) while providing transparency.
Rochester Medical Center
Why do you feel you were selected to receive the 3M Award for Excellence in Skin Safety? What made your organization stand out?
We submitted a document that detailed the history of how various nursing specialties collaborated to lower our pressure ulcer rates through data collection, analysis of data, hiring wound specialists, formal/informal education of nursing staff by specialists, support from administration regarding product acquisition and disseminating results to staff electronically, formal presentations, staff meetings and other means.
Describe your facility’s approach to preventing and treating IAD.
We use commercial wipes that include a cleanser and moisturizer/protectant for peri care. We also use skin sealant for our infants and for crusting denuded skin. We have reviewed our tiered approach with our pediatric hospitalists to ensure consistency.
Describe your facility’s approach to preventing and treating pressure ulcers.
Each of our WOC nurses has inpatient unit assignments and mentors the Skin Champions on those units. Many units, especially the adult critical care units, transitioned from single Unit Skin Champions to “Teams of Champions” to ensure there would be a “skin” resource nurse on all shifts. The WOC nurses round on all patient units weekly (except for psychiatry and ob/gyn) with a unit Skin Champion. Skin assessments, risk assessments, and recommendations for pressure ulcers prevention interventions and treatment interventions are discussed during rounds. The WOC nurse documents on those patients, for which new recommendations are made.
Additionally, the WOC nurse works closely with the NPs/PAs and residents/attendees to ensure all orders for skin prevention/treatment are up-to-date. The chief nursing officer, associate nursing directors of each of the nursing specialties (medicine, surgical, critical care, pediatrics, etc.) stay apprised of pressure ulcer incidence through our events reporting system. The nursing staff enters all new HAPU into this system. Also, a monthly meeting is chaired by the chief quality officer at which the incidence of all HACs including pressure ulcers is discussed. The WOC manager attends this interdisciplinary meeting. The WOC nurses also work closely with respiratory therapy, physical therapy, occupational therapy, nutrition, orthotics/prosthetics, and a variety of other med/surg services to collaborate on pressure ulcer prevention and treatment modalities.
What investments were necessary (e.g. financial, educational, technical, resources, leadership/management support, etc.) to implement your skin care program?
Investment in equipment and dressings is ongoing. We constantly evaluate what we have, what is new on the market, and what might be needed to keep lowering our pressure ulcer rates. Our goal is 0 percent. The WOC nurses provide formal education during nursing orientation, as well as a variety of informal or bedside education either by having nurses shadow for a day or by encouraging the nurse to be at the bedside when the WOC nurse is assessing the patient. There is total support for our skin care prevention and treatment from value analysis, purchasing, nursing administration, and nursing research as well as the hospital board of directors asking for updates on pressure ulcer rates.
Have any of your skin care protocols been updated or changed since you won the 3M award? If so, which ones?
We have created specific protocols for preventing a variety of device-related pressure ulcers, such as those associated with new tracheostomies.We also created “tool kits” and protocols for patients at high risk, such as those with new spinal cord injuries and those that are hemodynamically unstable.
How do you measure skin health outcomes? What have been your greatest successes in this area? Your greatest challenges?
Skin health outcomes are primarily measured by our NDNQI pressure ulcer rates, performance improvement projects that have looked at data before and after implementation of interventions and our patient satisfaction scores.
How have you earned staff buy-in across functions for patient skin health prevention and care?
Staff is educated from the time of hire and orientation and throughout their tenure at the hospital by a dedicated team of WOC nurses, nurse educators, unit-based clinical nurse specialists, and leaders. Policies are updated on a regular basis and specialists are kept updated on new products by maintaining a close relationship with our industry partners in collaboration with value analysis and professional organizations. The WOC specialists are excellent communicators, collaborators, and educators regarding maintenance of skin health and topical care of a variety of wounds.
In what ways have administration and management members embraced skin health?
Administration has been supportive to have additional WOC nurse positions, allowing unit-based Skin Champions dedicated time to round on patients, complete audits, and send emails out to their fellow staff members communicating updates on how well things are going, and whether there is room for improvement. Administration has also been supportive regarding the purchase or rental of specialty beds, and time to participate in research and performance improvement projects as they relate to skin health and prevention of HACs.
What is your top piece of advice for other organizations looking to improve upon their skin safety best practices?
Support from nursing administration and medical providers is paramount. Additionally, an organization also benefits with support from the board of directors and community in its efforts to provide better patient care. Hiring nurses that are certified in wound care, and ensuring they have administrative support regarding necessary products and resources needed to achieve desired results, is also vital for a successful skin program.
Lourdes Specialty Hospital
Why do you feel you were selected to receive the 3M Award for Excellence in Skin Safety? What made your organization stand out?
Lourdes Specialty Hospital has created and sustained a successful skin damage prevention program that demonstrates positive clinical outcomes, teamwork and knowledge transfer. The facility has a strong commitment to excellence in all aspects of care with supportive leadership. While tripling our hospital census and staff, the ability to decrease our HAPU rate to zero was a strong accomplishment.
Describe your facility’s approach to preventing and treating IAD.
We use a variety of preventive and treatment measures. All patients are evaluated for appropriateness of a Foley/external catheter or a fecal collection system when incontinent. We use moisture-wicking incontinence pads and apply zinc oxide barrier cream around every fecal collection system each shift. Moisture barrier is used on all patients with incontinence; products such as diapers are not used. Our patients are turned at a minimum every two hours.
Describe your facility’s approach to preventing and treating pressure ulcers.
Lourdes Specialty approach is a multidisciplinary one. Protective/preventive skin care measures are in place for every patient without exception. All nurses, nursing assistants, respiratory therapists, physical therapists, and occupational therapists are charged with protective/preventive skin care measures being maintained at all times.
SEE ALSO: Nurse Role in Skin Cancer Prevention
Our wound care mission is to ensure prevention of new wounds with a commitment to appropriate healing of wounds present upon admission. Each patient will have an individualized plan of care with interventions consistent with the following goals: 1) maintaining skin integrity to progress wound healing; 2) wounds will be free of signs/symptoms of infection; 3) patient will be pain-free; 4) education will be provided to the patient regarding wound care with emphasis placed on prevention; and 5) the patient and/or caregiver will be encouraged to take an active role in his/her wound management as appropriate to provide comprehensive and individualized care to each patient.
What investments were necessary (e.g. financial, educational, technical, resources, leadership/management support, etc.) to implement your skin care program?
Our hospital has invested in equipment that supports prevention of skin damage, including overhead ceiling lifts for turning/positioning, which significantly decrease friction or shearing of skin. Specialty mattresses may be ordered upon recommendation of wound care nurse. Pressure relieving cushions are available for use when the patient is out of bed in chair. Pressure relieving boots are available for use upon recommendation of wound care nurse. Overhead trapezes may be ordered upon recommendation of physical therapy. Wound VACs are available as ordered by physician.
Education is a key component to the success of our wound care program. It begins in orientation. The wound care team participates in orientation with lecture for every RN as well as hands-on skills. Each RN’s competency is signed off by a member of the wound care team. In addition to orientation, it is mandatory for every nurse to attend an annual skills fair where wound VAC competency is required. Additionally, there is mandatory annual wound care education for all nurses in our online Healthstream program. Vendors of wound care products and support surfaces frequently present in-services to our staff. Education is a continuing and daily ongoing process in our hospital for our patients, caregivers, and our staff. Our administrative leadership, as well as physician leadership, is engaged and committed 100 percent to our wound care program. Leadership is supportive of the wound care committee’s recommendations for any wound product or specialty device or support surface that is needed to maintain our wound care program mission.
Have any of your skin care protocols been updated or changed since you won the 3M award? If so, which ones?
None of our protocols have been updated or changed. All protocols have been reviewed and continue to support the needs of our program.
How do you measure skin health outcomes? What have been your greatest successes in this area? Your greatest challenges?
Outcomes are measured monthly based on the Bates-Jenson wound healing assessment tool. Quality outcomes are also maintained through performance improvement reporting and quality dashboards. Our greatest success has been maintaining a zero HAPU rate. Our greatest challenge is maintaining that rate as patient complexity continues to increase.
How have you earned staff buy-in across functions for patient skin health prevention and care?
All staff from the beginning of orientation are taught that each one of them is valued and an intricate part of the patient outcome process. Staff are kept up-to-date with patient outcomes and participate in a Patient Outreach Program where patients return to share their success. Every employee of our hospital is aware and committed to our goal of skin health prevention and our wound care mission. Our staff believes in providing a culture of quality and excellence in patient care.
In what ways have administration and management members embraced skin health?
Ongoing communication of facility-wide goals, measurements and outcomes are conducted and reviewed monthly with performance improvement audits. Complex wound care is one of the primary services that we provide to our patients as a long-term acute care hospital.
The content for this article was provided by 3M.
