VA Facilities and Reducing

Bedsores Team Ohana:

Morgan Thompson, Darren Okino, Yesenia Robles, Lauren Lovatto,

Jennifer Chinkatok HCA 450

Veteran Affairs facilities

● The US has the most comprehensive system of assistance for Veterans of any nation around the world. (Veteran Affairs, 2016)

● There are over 1000 VA facilities across the US● The VA Health Administration’s system has 152 medical

centers along with almost 1400 community based outpatient clinics, community living centers.

Bedsores found on patients ● Definition: Bedsores — also called pressure sores or pressure ulcers — are injuries to skin and underlying

tissue resulting from prolonged pressure on the skin.○ They most often occur on skin that covers bony areas such as hips, heels, ankles, etc.

● Causes: ○ Sustained Pressure○ Friction○ Shear

● Four Stages of Severity:○ Stage one○ Stage two○ Stage three○ Stage four○ Unstageable

Bedsores (pressure sores). (2014, December 13). Retrieved April 19, 2016, from http://www.mayoclinic.org/diseases-conditions/bedsores/basics/causes/con-20030848

Bedsores vs. VA facilities ● About 12.3% of all facilities reported increased

rates of bedsores ● Highest increased rates were long-term care

facilities● One severe bedsore can cost a facility up to

$70,000● Throughout the United States $17 billion is

spent on treatments for bedsore per year● Medical and Medicare see bedsore as

preventable, so in many occasions will not reimburse for additional services

Peterson MJ, Gravenstein N, Schwab WK, van Oostrom JH, Caruso LJ. Patient repositioning and pressure ulcer risk—Monitoring interface pressures of at-risk patients. J Rehabil Res Dev. 2013;50(4):477–88. Retrieved April 19, 2016, from http://dx.doi.org/10.1682/JRRD.2012.03.0040

Fishbone Diagram

Patients developing bedsores.

PeopleEnvironment

Patient Risk Factor Equipment

In adequate amount of nurses

Age

Lack of knowledge about bedsores

Patients staying in one position for a long period of time.

Nurses lack enough time to turn and check patients every two hours

Monitoring the amount of times patients have been turned

Moist and Warm environment

Poor nutrition and hydration Patients need of higher surface to spread body weight

Patients on certain medications or with certain medical conditions

Outdated beds and wheelchairs

Changing wound dressings frequently to prevent moisture and bacteria from forming

● Bedsores (pressure sores). (2014, December 13). Retrieved April 19, 2016, from http://www.mayoclinic.org/diseases-conditions/bedsores/basics/causes/con-20030848

Current state of issues • Statewide comprehensive bedsore prevention and policies

needed • Improve reporting and documenting bedsores• 75% of our patients need to be educated on bedsores and

bedsore prevention• Increase of 24% of patients need to be educated on

bedsores and bedsore prevention

Purpose StatementTo develop a reliable system to help decrease the

amount of facility acquired bedsores on patients while staying in VA facilities.

Goals● To design a program that would reduce the amount

of uneducated patients by 50 patients (21%)● To prevent the development of bedsores, while

decreasing cost and patient complications.

Scope● 240 Patients of whom developed bedsores during

their stay at 24 VA facilities

Data Points Data Points Source How Long? How Often? Baseline

A quarterly survey that will show the percentage of facilities being informed on bedsores

Quarterly survey 1 year 1 time/month 8 of 24 (33%) of facilities

Frequency of reported education on bedsores to patients

Documentation (reports of education on bedsores for patients by staff)

6 months As it occurs 117/240 (49%) patients

http://www.va.gov/oig/54/reports/VAOIG-05-00295-109.pdf

Data Points

Data Points Bedsores development during

Hospitalization- BaselineTarget

Patients NOT being educated on bedsores

123 (51% of patients) Reduce to 50 patients (21%)

Percentage of facilities requiring clinicians to educate their patients on bedsores

8 of 24 (33%) of facilities Increase by 10 facilities (18 facilities in total, 75%)

http://www.va.gov/oig/54/reports/VAOIG-05-00295-109.pdf

Patients develop bedsores

Improper assessment

Reduce the development of facility acquired bedsores while in the VA

Facilities by 20% in the next six months

Contribution20% of patients

developing bedsores during

hospitalization

70% currently developing bedsores

during hospitalization

Bedsore development rate is at 50% above the expected target of 20%

{Ultimate Goal}

{Current Situation}Facilities must have clinician

spend 3 minutes educating the

patients on bed sores

Patients need to become educated

on bedsores

{Problem To Tackle}

{Target}

{Process}

Patients are not turning or

adjusting themselves

Clinicians are not educating patients about

bedsores

Facility policies are not addressing bedsore education

to clinicians

Patients are not being turned

Clinicians are busy

Patients are not educated on bedsores

Clinicians assess

patient for bedsores

Patient is classified “at risk”

Clinician explains

care plan to patient

Clinician reassesses patient for bedsores

Clinicians and team

create a care plan

Target Condition Target: Facilities must have a policy in place which has clinicians need to spend at least 3 minutes educating the patient on bedsores

● Causes of bedsores needs to be discussed● Proper turning methods and weight shifting ● Q2H turning importance● Risk factors and prevention

In order to achieve the target:

● The education department needs to create an instructional class which prepares clinicians on how to educate their patients on bedsore prevention.

Break Down the ProblemReasons for developing Hospital Acquired Bedsores:

1. Patients not turning themselves (We are addressing this one)a. High severity and easier to addressb. Allows for repositioning without clinician interaction (problem 2)

2. Patients not being turned by cliniciansa. Due to clinician unavailability from distractions and interruptionsb. Harder to address

3. Initial assessments flaweda. Assessments deal with risk factors and not actual causesb. Requires more data from multiple departments

Analyze the Root Cause● Patients are developing Facility Acquired bedsores● Patients apply pressure to at risk locations● Patients are not being turned and are not turning themselves● Patients do not have the proper education to turn themselves● Clinicians are not educating patients on bedsores● No facility wide policies to address teaching patients on

bedsores

Implementation Projects Phase one: Education departments need data on proper teaching and proper turning and prevention

Phase two: Create classes either online clinician portal or in classroom

Phase three: Application to patient

Phase four: Monitoring amount of facility acquired bedsores

Counter-Measure Plan Who will be involved in test? All VA facilities, Education departments, Clinician staff, patients

What specifically are they going to do? Education department is going to create an informational program for nurses in order to teach patients about bedsores and bedsore prevention. Clinicians will use new information to teach patients about bedsores and bedsore prevention. Patients with the new information will know the importance of bedsore prevention and will turn themselves.

When will we test? Day? Time of day? How many times? We will test Mondays and Fridays of each week. 7am to 7pm per admission. Within four hours of each admission with 7am and 7pm.

Where will we do it? The patients rooms and the training at an off site location.

How will we know if the changes worked? A decrease in facility acquired bedsores from educated patients.

Risk in implementing the counter-measure? Clinicians may not have enough time to do this. Some patients will not be able to turn themselves due to current conditions. Some patients might refuse to turn themselves. Patients might forget to change positions.

Data Points

Data Points Baseline Target Expected Results

Patients NOT being educated on bedsores

123 (51% of patients) Reduce to 50 patients (21%)

80 patients (33% of patients)

Percentage of facilities requiring clinicians to educate their patients on bedsores

8 of 24 (33%) of facilities Increase by 10 facilities (18 facilities in total, 75%)

15 of 24 (62%) of facilities

Our Reflection: Team Ohana and Project

Ohana: means family, family means no one gets left behind.

. Develop and describe the team meeting management skills used to accomplish your project to tell a story (Includes Team Dynamics)

• Darren being Type 1 was able to come up with options that has helped the group decide on what to do to make the project better as well as improved listening skills and explained very well about the details needed to cleared up.

• Yesenia being Type 2 was able to work with everyone in the group as well as helped with connecting with Youngjae to clarify any of the issues that occurred during the project completion.

• Lauren being Type 2 was able to give and find the group information that was needed to complete the project.

• Jennifer being Type 3 was able to connect all group members together to make sure things were getting done. Also helped set up our PowerPoint.

• Morgan being Type 4 helped explain the group's’ confusion as well as helped manage how the group was able to complete the project.

- Darren Type 1: Controller - Yesenia Type 2:

Persuader - Lauren Type 2: Persuader- Jennifer Type3:

Organizer- Morgan Type 4: Analyzer

Overall with a group that has all types of personalities, we were able to come together and figure out the issues of our project, settle confusion, and come to a compromise of opinions and really listen to everyone to finally make this project happen.

Reference About VA. (n.d.). Retrieved March 30, 2016, from http://www.va.gov/about_va/vahistory.asp

Peterson MJ, Gravenstein N, Schwab WK, van Oostrom JH, Caruso LJ. Patient repositioning and pressure ulcer risk—Monitoring interface pressures of at-risk patients. J Rehabil Res Dev. 2013;50(4):477–88. Retrieved April 19, 2016, from http://dx.doi.org/10.1682/JRRD.2012.03.0040

Bedsores (pressure sores). (2014, December 13). Retrieved April 19, 2016, from http://www.mayoclinic.org/diseases-conditions/bedsores/basics/causes/con-20030848

Watrous, J. (2006, March 22). Management of Patients with Pressure Ulcers in Veterans Health Administration Facilities. Retrieved February 22, 2016, from http://www.va.gov/oig/54/reports/VAOIG-05-00295-109.pdf

QUESTIONS?