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    Cochisefoxtail Qualityimprovementpresentation

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    Cochisefoxtail Qualityimprovementpresentation

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    api-740100360
    52 views17 pages

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    cochisefoxtail qualityimprovementpresentation

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    52 views17 pages

    Cochisefoxtail Qualityimprovementpresentation

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    api-740100360

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    Preventing Hospital

    Associated Pressure
    Injuries (HAPI):
    New Grad RN HAPI Prevention
    Education Program

    Cochise Foxtail: Brenna Gaulton, Lynn Ly, Ava


    Mangiafico, Joanna Scheidt, Sydney Okoneski
    Hospital
    Unit Introduction Flat Organizational Leadership Structure
    ● Unit Director of Nursing
    ● Unit Supervisor/Manager
    Northwest Medical Center (NWMC) ● Charge Nurse
    ● Tucson, AZ ● Bedside Nurses
    ● Medical-Surgical Intensive Care Unit
    (MSICU)
    ● Critically ill patients with medical, Staffing
    surgical, and neurological diagnoses ● Registered Nurses
    ● Nurse Manager
    ● Nurse Educator
    MSICU Demographics
    ● Patient Care Technicians
    ● 20 beds
    ● Respiratory Therapists
    ● Daily census of 10-16
    ● Physicians
    ● Ratios of 1:1-1:3
    ● Critical Care Nurse Practitioners
    ● Adult (18+)
    ● Physical and Occupational Therapist s
    ● Diverse population
    Issue: HAPI Incidence
    HAPI Current Actions
    ● “Never Event” ● 4 eye skin assessment on
    ● Unprecedented spike Aug-Sept 2023 admission & Qshift
    ● Skin bundle
    Knowledge Gap ○ Moisture barrier
    ● Spike following July New Grad RN cohort ○ Sacral foam dressing
    ● Lack of nutrition assessment & dietitian (Mepilex) Q24H
    consults ○ Specialized air mattress
    ○ Pillow under bony
    Compliance prominences
    ● Witnessed procedural policies not being ○ Float heels
    implemented ○ Q2H turns
    Forming the Team (Al-Otaibi et al., 2019)

    ● Wound Care Team ● Quality Improvement Advisor


    ○ Education and training ○ Monitoring and evaluation
    ○ Expertise ○ Guidance and supervision
    ○ Direct involvement ○ Interdisciplinary collaboration

    ● MSICU Nurses ● Clinical Nurse Educator


    ○ Direct patient care ○ Curriculum development
    ○ Reports information ○ Ensures compliance
    ○ Patient advocates ○ Facilitates staff education
    AIM Statement

    To reduce the incidence rate of monthly MSICU patient


    HAPIs to 0 by January 2024 compared to the 12.7 incidence rate in September
    2023 by implementing a mandatory New Graduate RN HAPI Prevention
    Education Program for new MSICU nurses at NWMC.

    AIMS to improve:
    ● Efficiency
    ● Effectiveness
    ● Safety

    (Institute for Healthcare Improvement, n.d.)


    HAPI Incidence Rates
    Establishin Measured monthly
    g Measures ● (# of HAPI occurences / # of patient admission to the unit)

    Unit Data
    ● May 2023: 2 occurrences, incidence rate of 4.5
    ● June 2023: 2 occurrences, incidence rate of 4.5
    ● August 2023: 3 occurrences, incidence rate of 7
    ● September 2023: 5 occurrences, incidence rate of 12.7
    ● November 2023: 1 occurrence, incidence rate of 2.3
    ● January 2024: 1 occurrence, incidence rate of 2.2

    National Data for HAPI Incidences


    ● Average incidences of pressure injuries in critical care patients in
    U.S. hospitals
    ● Average yearly HAPI incidence rate: 5.85
    Selecting Changes
    Create a mandatory New
    Grad RN HAPI Establish a specialized
    1 Prevention 2 pressure ulcer nurse at
    Education Program NWMC
    ● Spike following New Grad cohort
    ● Only 23% of new grad RNs
    demonstrate entry-level competencies Incentivise nurse compliance
    ● New grad RN educational programs 3 to NWMC HAPI
    enhance critical thinking & preventative measures
    competency
    ● Pressure injury (PI) training programs
    help improve knowledge, visual
    discrimination ability, & clinical
    judgement
    Testing Changes: Plan
    Objective
    ● Diminish the knowledge gap of New Grad RNs regarding HAPI prevention and increase their
    compliance to NWMC HAPI prevention procedures to reduce the HAPI incidence rate to 0 in the
    MSICU.

    Questions Answered
    ● Does the introduction of a New Grad RN cohort correspond to the following 2 month spike in HAPI
    incidences in the MSICU at NWMC?

    Predictions
    ● Once the program begins and throughout its duration, HAPI incidences will decrease, and by the end
    of the program, the incidence rate will be 0 in the MSICU at NWMC.
    Testing Changes: Program Plan
    Structure
    ● 1 mandatory 2 hour class each month for 6 months, each covering 1 competency
    ● 2 classes lead by Clinical Nurse Educator each month in reserved conference room
    ● Lectures, demonstrations, case studies & skill practice

    Curriculum
    ● Current NWMC HAPI prevention procedures
    ● Content: (1) Etiologies & risk factors, (2) Risk & skin assessment, (3) Positioning &
    supportive devices, (4) Nutritional interventions, (5) Impact of change of condition, (6)
    Documentation & referrals

    Evaluation
    ● Pre-test and pass/fail post-test
    Testing Changes: Do & Study
    Do
    ● Collect data on HAPI incidence rates each month before, during, & after program
    ● Collect data on documentation of risk & skin assessment, prevention interventions, and
    referrals (if indicated) for every patient

    Study
    ● Data re-evaluation intervals based on program for next cohort (July-Dec 2024)
    ● Analyze trends:
    1) 2 months prior to program (May-June)
    2) 2 months into program (Sept-Aug)
    3) 2 months following program (Jan-Feb)
    4) 1 year following end of program (Dec 2025)
    Potential Barriers

    New Grad RN Resistance to New Lack of Leadership Support


    Educational Program (Education (Leadership)
    and Training)
    Interventions:
    ● Provide evidence-based data
    Interventions:
    ● Allocate $600 for incentives that supports the need for the
    and recognition awards for implementation of a HAPI
    staff Prevention Education Program.
    Timeline
    References
    Al-Otaibi, Y. K., Al-Nowaiser, N., & Rahman, A. (2019). Reducing hospital-acquired pressure injuries. BMJ Open Quality, 8(1).

    https://doi.org/10.1136/bmjoq-2018-000464

    Cox, J., Edsberg, L. E., Koloms, K., & VanGilder, C. A. (2022). Pressure injuries in critical care patients in US hospitals: results of

    the international pressure ulcer prevalence survey. Journal of Wound, Ostomy, and Continence Nursing, 49(1), 21–28.

    https://doi.org/10.1097/WON.0000000000000834.

    Institute for Healthcare Improvement. (n.d.). How to improve: model for improvement: setting aims. Institute for Healthcare

    Improvement. https://www.ihi.org/resources/how-to-improve/model-for-improvement-setting-aims

    Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate

    nurses’ clinical reasoning. Nursing Education Perspectives, 38(2), 57–62. https://doi.org/10.1097/01.nep.0000000000000112


    References
    Kim, G., Park, M., & Kim, K. (2020). The effect of pressure injury training for nurses: A systematic review and meta-analysis.

    Advances in Skin & Wound Care, 33(3), 1–11. https://doi.org/10.1097/01.asw.0000653164.21235.27

    National Pressure Injury Advisory Panel (NPIAP). (2023). Standardized Pressure Injury Prevention Protocol (S-PIPP).

    https://npiap.com/

    Rush, K. L., Janke, R., Duchscher, J. E., Phillips, R., & Kaur, S. (2019a). Best practices of formal new graduate Transition

    programs: An integrative review. International Journal of Nursing Studies, 94, 139–158.

    https://doi.org/10.1016/j.ijnurstu.2019.02.010
    Thank You
    Do you have any questions?

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