Regions Hospital Skin Wound Action Team (S.W.A.T.) - Patient Safety Improvement
Summary:
To help prevent serious hospital-acquired pressure ulcers, Regions Hospital introduced the
Regions Skin Wound Action Team, or SWAT. Similar to a Rapid Response Team, SWAT is an
early intervention team that responds during the very early stages of a pressure ulcer. Working
with the patient care team, patients and the family, the SWAT develops a rigorous plan of care to
resolve the pressure ulcer and prevent further skin breakdown. The SWAT was so beneficial and
effective in the critical care units, where it was piloted, that it was fully implemented throughout
the hospital.
Narrative/Nomination:
One of the more recent and successful initiatives of the Regions Safeskin 2.0
Interdisciplinary Collaborative is our Skin Wound Action Team (SWAT). (See Appendix A.)
Culture of Patient Safety - Regions Hospital is a Level I Adult and Pediatric Trauma
and Regional Burn Center caring for patients who are very complex and at high risk for Hospital
Acquired Pressure Ulcers (HAPUs). In 2010, Regions re-energized an interdisciplinary and
interdepartmental team of key leaders throughout the organization to align with the MHA
Safeskin 2.0 Campaign, conduct a gap analysis, follow and employ best practices of the MHA
Roadmap for the prevention of HAPUs in the acute care setting.
Despite our efforts, Regions experienced an increase in reportable HAPUs during the
2011 – 2012 Adverse Health Event Reporting Period, with 11 unstageable and 1 Stage III
HAPU. Of these reportable HAPUs, 70% were attributable to critical care areas and 30% were
device related. In response, the Safeskin 2.0 Interdisciplinary Team, in collaboration with the
Advanced Practice Nurses, created a Skin Wound Action Team (SWAT) using the Rapid
Response team model. The SWAT is an early intervention team that responds during the first and
second stages of an HAPU by working with the patient care team to develop a rigorous,
preventative plan of care while educating and engaging the patient, family and entire care team
in that plan of care to resolve the pressure ulcer and prevent further skin breakdown. (See
Appendix B.) The pilot began in Q3 2012 throughout Critical Care and the process was so
beneficial and effective, it spread throughout the hospital to full implementation by Q4 2012.
Demonstrated Effectiveness - Since the implementation of the SWAT in mid-2012, we
have on record 67 SWAT activations for Stage I, II, or suspected deep tissue injuries (sDTIs) to
date. Of those 67 patients (seen by SWAT) 18%, or 12 total, progressed to a Stage III, IV or
unstageable HAPU. In addition: Of those 67 patients, 37 were sDTIs, and 16%, or 6 of the 37,
progressed to a reportable Stage III or IV pressure ulcer while remaining in our care. Of the 31
others that did not progress to reportable stages, approximately 40% resolved in our care; the
remaining were discharged from the hospital. (Data was not available on these patients after
discharge.) This is significant because according to the literature, approximately 1-2% of
suspected sDTIs do not progress to a Stage III, IV or unstageable HAPU.
Since the implementation of the 2010 Safeskin 2.0 Interdisciplinary Team and SWAT
Team, Regions continues to make progress toward our Target Zero Pressure Ulcers prevalence
goal. For example, in the 2012 – 2013 reporting period for Adverse Health Events, Regions
decreased its HAPU reportables by 30% from 12 to 8. In addition, Regions continues to decrease
our prevalence rate and is significantly below the National Database of Nursing Quality
Indicators (NDNQI) national 2013 average prevalence rate (1.5% versus 2.5-5% for similar size
and teaching hospitals). We see a significant decrease in our respiratory device related pressure
ulcers with new interventions by the SWAT team such as using gel foam to offload pressure
from CPAP/BiPap masks.
Additional steps the Safeskin 2.0 Team took in 2013 to improve the quality of care and
safety included employing the MHA consultant for a full program assessment and gap analysis
recommendations of our Pressure Ulcer Prevention Program. The Safeskin 2.0 Interdisciplinary
Team is monitoring all skin-related action plans from adverse health events to ensure there is
follow-through on action items as well as organization-wide dissemination of best practices.
Evidence of Spreading Initiative – The SWAT concept was promoted throughout the
organization through our Quality and Performance Improvement Councils which include the six
HealthPartners Acute Care facilities, with discussions of a pilot at another facility soon. Since the
inception of the Regions Hospital Safeskin 2.0 Interdisciplinary Team and the SWAT
implementation, individual members are active in disseminating and improving quality of care
and safety to patients beyond the walls of Regions Hospital. (See Appendix C for full list of
activities regarding evidence of spreading initiative.)