In August of 2015 the committee previously known as the Pressure Ulcer Committee, adopted a new name. The new name, Skin Injury Prevention Committee, is inclusive of the injuries which occur to patients due to medical equipment. Ironically, shortly after, the National Pressure Ulcer Advisory Panel (NPUAP) adjusted their definitions to reflect skin injuries beyond pressure ulcers as well.
Beginning in July 2015, the Skin Injury Prevention Committee expanded the monthly audit process from the critical care areas to all of the inpatient nursing units. In January of 2016, the Skin Injury Prevention Committee established a deep dive process for all hospital acquired skin injuries. The deep dives provide a new layer of data previously not available, such as ease in collating trends for location of pressure injury and stages of pressure injury. The role of Skin Champion has been invaluable to the deep dive process, working through many process issues and data reconciliation resulting in clean data.
This data can be reviewed by Spectrum Health Grand Rapids (SHGR) overall, by campus (Butterworth Hospital, Blodgett Hospital or Helen DeVos Children’s Hospital), or by clinical unit. Additionally, the deep dives assist in the identification of trends that the Skin Injury Prevention Committee is beginning to explore: long surgical cases, medical devices, heels and coccyx injuries. In FY16, a total of 92 deep dives were completed for SHGR. Lastly, the Skin Injury Prevention Committee has begun a partnership with surgical services to dig into practice considerations for long surgeries, typically those greater than three hours.
The Skin Injury Prevention Committee also partnered with Informatics to optimize I-VIEW skin documentation. This is inclusive of: wounds, skin injuries, and bathing/daily care. These changes were implemented in September 2016. Lastly, education resources that serve as the primary resource to staff for skin injury prevention products, practices, and include pictures, were updated.
While we are meeting our Magnet goal for HAPUs, we are not yet meeting the goal of zero harm. Expanding the skin audits to monthly allows the team to get a better understanding of HAPUs guiding targeted interventions. The team reviews overall pressure ulcers and comparison to HAPU stage 2 or greater. In March 2016 there was a spike in HAPUs to 35 however less than 35% were stage 2 or greater. It is too early to determine if the I-VIEW Skin documentation interventions have impacted the HAPU rate.
Nardos Osterhart MSN, RN, NE-BC
Molly Christians MSN, RN-BC, AGCNS-BC, PCCN
Sarah Fisher MSN, RN
Kelli Schutter BSN, RN
Richard Hodgson MD
Donna Luckett BSN, RN
Sheryl Boonstra RN, CCRN
Marcia MacGeorge RN
Jessica Pratt BSN, RN, CNRN