In New Jersey, an Effort to Reduce Pressure Ulcers
Recognizing that pressure ulcers are still a problem across the care continuum in the state, the New Jersey Hospital Association (NJHA) recently launched a 1-year project called The NJHA Collaborative to Reduce the Incidence and Severity of Pressure Ulcers throughout the Continuum of Care. The goal is to reduce pressure ulcers across all settings by 25% through improved communication, prevention, and assessment.
The partners in this effort are the NJHA's Department of Continuing Care Services and its Quality Institute. The collaborative is endorsed by the New Jersey Department of Health, the Health Care Association of New Jersey, the New Jersey Association of Non-Profit Homes for the Aging, and the Home Care Association of New Jersey.
The idea for the collaborative grew out of a series of meetings attended by Theresa Edelstein, LNHA, Vice President of Continuing Care Services, and Aline Holmes, RN, APNC, MSN, APRN,BC, CNAA, BC, Director of the Quality Institute. After attending state quality improvement meetings, the two realized that no significant progress had been made in reducing pressure ulcer prevalence in the state. They believed that the NJHA's collaborative model could be used to bring together health care organizations from across the care continuum to solve the pressure ulcer problem.
"We may not be able to do anything about some percentage of pressure ulcers," Ms Holmes said, "but there are others that we can prevent. We want to be as aggressive as we can."
Sharing a Common Goal
What exactly is the NJHA collaborative model? In essence, it is a commitment that health care organizations make to each other to improve patient safety and quality care.
Each health care organization enrolled in the collaborative-whether from acute care, long-term care, or home health care-is expected to form a partnership with other health care organizations to achieve common goals; in this case, to reduce pressure ulcer prevalence. Focus areas for the collaborative include:
* measuring incidence and severity of skin breakdown in patients after implementing recommended interventions
* reducing exposure to friction and shear and managing tissue loading
* identifying an optimal set of pressure ulcer prevention techniques.
The health care organizations pay a fee to become part of the collaborative. This fee entitles them to participate in the collaborative's multipronged approach of education, ongoing support, and conference calls with the experts. For example, the October conference call featured Barbara Braden, PhD, RN, FAAN, who discussed risk assessment and how to use the Braden Scale.
Participants will be involved in 3 learning sessions and monthly conference calls; they will have access to expert faculty; and they will receive ongoing feedback and assistance from NJHA staff, a "change packet" and a toolkit of interventions. Following each learning session, team members implement the concepts and ideas presented, referred to as "action periods."
Data analysis and review are important to the process. Elizabeth A. Ayello, PhD, RN, APRN,BC, CWOCN, FAPWCA, FAAN, a senior advisor to The John A. Hartford Institute for Geriatric Nursing, is chairperson of the collaborative. She noted that the participants' knowledge of pressure ulcer prevention and treatment will be measured periodically with a validated tool. After the 12-month collaborative period, "we can compare these data to other studies and data."
Getting Down to Business
The first 2-day learning session was held in September. It included presentations from a number of experts in the wound care field, as well as time for participants to ask questions about pressure ulcers. Among the faculty were Sharon Baronoski, MSN, RN, CWOCN, APN, DAPWCA, FAAN; Dan Berlowitz, MD, MPH; Fran Griffin, RRT; JoAnn Maklebust, MSN, APRN-BC, AOCN, DAPWCQ, FAAN; Mary Ellen Posthauer, RD, CD, LLD; Jack Scharf, MBA, CPHQ, FACHE; and Karen Zulkowski, DNS, RN, CWS.
"The quality of the program was sensational," Dr Ayello said. "We had some of the leading experts in pressure ulcer care and treatment, as well as experts at mentoring people for change. There was a keen sense of partnership and collaboration."
Ms Edelstein was also pleased with the kickoff session. "I felt an incredible amount of energy and excitement in the room. Nursing homes, in particular, have focused on pressure ulcer care for some time. But we've never had participants across the continuum in the same place at the same time, ready to deal with what happens with people's skin when they travel across facilities."
Partnering staff from different facilities was a primary component of the initial learning session. Attendees did more than listen to speakers; they had to work with colleagues from other facilities to formulate the action plans for the 12-month collaborative project.
About 40 teams were formed among the nearly 120 participating organizations, under the watchful eye of the NJHA staff. Each team wrote an "aim statement" for both the partnership and for their facility. Examples of key partnership goals are better communication when patients are transferred from one facility to another, and ensuring that proper preventive measures are taken on admission to a facility. Ms Holmes noted that participants expressed an interest in developing and streamlining a tool or system that would help improve communication between partnering facilities.
Dr Ayello also offered participants 2 "memory joggers" during the learning session: the NO ULCER and the SEND mnemonics that she developed. For more on these mnemonics, see Table 1.
The collaborative's next educational session is slated for February 2006.