Before the IHI campaign put a spotlight on bedsore prevention, St. Francis already was working on the problem. In July 2002, 9.4% of its patients acquired pressure ulcers. That number was knocked down to 4% by March 2005, 2.5% by December 2008 and below 1.6% by June 2012. By 2009, St. Francis said it was saving $3 million annually through the reduction in pressure ulcers. While those figures were impressive, there was concern that progress had stalled.
“We got rid of the low-hanging fruit,” said Kelly Nimtz-Rusch, a nurse who serves as director of clinical practice at St. Francis. “That's when you begin to say, 'Now what more can we do?' ”
Because every department had already implemented standard prevention practices, it became necessary to look into each specific area and ask, 'What are your barriers?' ” she said.
A closer examination found that some immobile patients in the cardiovascular intensive-care unit were still getting pressure ulcers. But rather than getting the ulcers from lying in bed, they were being caused by patients sitting in a chair for long periods of time. “Sitting was good for their heart and lungs, but bad for their bottoms,” Nimtz-Rush said.
Patients who undergo long surgeries may suffer deep-tissue injuries that put them at risk for pressure ulcers in the areas of the body with bony prominences. The solution was to give patients a “prophylactic sacra dressing” on their backside prior to surgery to help maintain skin integrity post surgery. Surgeons included the dressing in their pre-op orders, and patients and families were instructed about what was being done and why.
“In those six months, we have not seen a pressure ulcer in that area,” Nimtz-Rush said.
Another group of patients at risk of pressure ulcers were babies in the pediatric ICU who developed skin problems on their nose, back of the head or other areas where medical devices were attached to them.
Nurse Bevette Griffin said special gel pods have been found to reduce these types of sores in pediatric ICU patients. Nurses receive special instructions to be constantly aware about the risk of pressure ulcers and are taught how to attach the gel pods to babies and how to lay the baby down in a position that reduces the risk of injury.
Pressure ulcer prevention and other quality improvements require a constant effort, Griffin said. “I don't think anybody can put a project into place and think it's going to be perfect, because it never is.”
Along with three other certified wound nurses, Griffin heads up the Save Our Skin nursing team at St. Francis, which holds monthly meetings to review data and educate staff on new products and prevention techniques.