Schaffer Extended Care: A Comprehensive Approach to Pressure Ulcer Management

Schaffer Extended Care Center Staff. Standing, left to right: Lorraine Grant, CNA; Sherly Koshy, Nursing Care Coordinator; Marcia Lewis, RD; Cornelia Fleming, Director of Nursing; Joan Portnoy, Administrator; Richard Barone, Medical Director. Seated, left to right: Marina Praete, Nursing Care Coordinator; LillyAnn Sten, CNA; Hopelyn Welch, CNA; Eunice James, CNA; Paula Coleman, Nursing Care Coordinator

In August 2003, Schaffer Extended Care Center began working with the IPRO NHQI team, and chose to focus on pressure ulcers. Although the team believed they already had a good program, they saw an opportunity to critique and potentially enhance it.

Staff at Schaffer used the FADE (Focus, Analyze, Develop, Execute) methodology to develop a problem statement, brainstorm ideas, and create a fishbone diagram to outline various contributory facets, then begin the process of improvement.

An interdisciplinary committee including representatives from Administration, Medicine, Nursing, Rehabilitation Therapy, Social Work and Nutrition was formed. Enthusiastic and forthright in discussing problems, analyzing data and making recommendations, committee members accomplished a great deal:

Although weekly wound care rounds had occurred for many years, the Medical Director developed a structured form for documentation. The form standardizes documentation, ensuring that all aspects are assessed (site, size, drainage, stage, nosocomial versus community acquired, treatment) and permits quick review of progress over time.
Display of heel products; evaluation and selection of products for prevention and treatment; and development of a Heel Ulcers Prevention and Treatment Protocol.
Evaluation of pressure-reducing mattresses and eventual purchase of 15 specialized mattresses.
Development of rates for total pressure ulcers and nosocomial pressure ulcers and introduction of control charts.
Review and revision of policies and procedures related to skin assessment and pressure ulcers.
Development of a standardized protocol for use of skin barrier cream.
Purchase of medical-grade cameras for accurate documentation of pressure ulcers.
Development of a Nosocomial Pressure Ulcer Investigation Form.
Adoption of the Braden Scale.

The committee continues to meet regularly to review current status and monitor the rates of total and nosocomial pressure ulcers. The percentage of pressure ulcers healed each month is also monitored. The rate of nosocomial pressure ulcers remains low and the percentage of healed pressure ulcers is high.

Participation in this Quality Improvement Initiative has been a positive one for Schaffer. Director of Nursing Cornelia Fleming reports that staff members have benefited from the focused review of the process and take pride in their accomplishments.