Pressure Ulcer Intervention and Data Collection

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Pressure Ulcer Intervention and Data Collection
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Pressure Ulcer Bundle

• 1. Conduct a Pressure Ulcer Admission Assessment
  for All Patients
• 2. Reassess Risk for All Patients Daily
• FOR AT RISK PATIENTS (from above)
• 3. Inspect Skin Daily
• 4. Manage Moisture
• 5. Optimize Nutrition and Hydration
• 6. Minimize Pressure

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PU Process MeasurePercent at risk patients
receiving full bundle

• Definition The percentage of patients identified
  as at risk for pressure ulcers for whom all
  components of proper pressure ulcer care were
  performed and documented in the calendar day
  prior to review. If a component of care is not
  applied due to a documented contraindication,
  count it as appropriately performed for the
  purposes of this measure. Proper pressure ulcer
  care includes the following five components
• Daily inspection of skin for pressure ulcers
• Proper management of moisture, including both
  cleaning and moisturizing skin
• Optimization of nutrition
• Repositioning every two hours
• Use of pressure-relieving surfaces

IHI Measurement Forms, Pressure Ulcers
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PU Bundle Calculation Details

• Numerator Definition Number of patients
  identified as at risk for pressure ulcers for
  whom all components of proper pressure ulcer care
  were performed and documented in the calendar day
  prior to review.
• Numerator Exclusions None 
• Denominator Definition Total number of patients
  identified as being at risk for pressure ulcers
• Denominator Exclusions Patients admitted on
  current day or prior calendar day
• Measurement Period Length Weekly
• Calculate as (numerator/denominator) x 100 as
  percent

IHI Measurement Forms, Pressure Ulcers
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Tips for PU Bundle Compliance Measurement

• All-or-none measure, but if contraindication is
  properly documented, credit is given
• This does NOT measure assessment effectiveness,
  which you may want to measure separately
• Use a standardized form in patient chart to
  collect data

IHI Measurement Forms, Pressure Ulcers
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Sampling Plan

• Conduct the sample one day per week, choosing the
  day of the review at random.
• Review as few as 10 patients per week
• Choose patient records randomly from identified
  at-risk patients. If there are insufficient
  admissions on the given day, incorporate patient
  records from the previous day in your sample.
• As your team becomes more comfortable with the
  reviewing process, you may increase the number of
  charts reviewed.
• If you are beginning this intervention within a
  pilot unit or units, limit your initial
  measurement to only those units. As you spread
  the implementation, expand your measurement
  accordingly.

IHI Measurement Forms, Pressure Ulcers
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PU Outcomes MeasurePressure Ulcer Incidence Per
1000 Patient Days

• Numerator Definition Number of pressure ulcers
  developed in hospital
• Numerator Exclusions None
• Denominator Definition Total number of patient
  days
• Denominator Exclusions None
• Measurement Period Length Monthly
• Definition of Terms You define
• Calculate as (numerator / denominator) x 1000
  as rate

IHI Measurement Forms, Pressure Ulcers
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PU Incidence Collection Strategy

• There are two recommended strategies for
  collecting data used in this measure
• Via a form which includes documentation of new
  pressure ulcers in the chart.
• A variant of this method is to create forms that
  document the development of a new pressure ulcer,
  which nurses should submit to the units charge
  nurseor to some central body.
• Include only patients with completed stays in
  the data collection for this measure.

IHI Measurement Forms, Pressure Ulcers
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PU Incidence Sampling Strategy

• Limit your measurement activity in this measure
  to only patients that have been identified as at
  risk, either at admission or during their stay.
• If you are beginning this intervention within a
  pilot unit or units, limit your initial
  measurement to only those units.
• Beyond limiting your sample to at-risk patients
  and patient in your pilot unit(s) as described
  above, you should try not to further reduce your
  sample size, as incidence rates of pressure ulcer
  are typically low.

IHI Measurement Forms, Pressure Ulcers