Habersham Medical Center
Tallulah Falls Community Group
For Regional Two/B
Habersham Medical Center

 Acute Care Hospital Licensed for 53 Beds.
 Long Term Care for 84 Residents
 HCMC Home Health Agency
 Six Physician Practice Offices
 Community Wellness Program
Image of Habersham Medical Center
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Mission Statement

Habersham Medical Center’s mission is
to provide high quality caring a
compassionate, professional and
economical manner to all persons in
Habersham County and adjacent areas.
In the beginning…

Acknowledging We
Had A Problem
Listened to our
Community

 Data did not reflect a need to focus on pressure ulcer
prevention.
 Identified physician documentation did not
routinely include skin assessments and findings.
 Available data came from coding from physician
documentation only.
 Formulated a multidisciplinary Wound Care Team.
 Hosted our Tallulah Falls Community meeting with
GMCF to address community pressure ulcers.
Tallulah Fall Meeting

 Met our neighbors to put a face with a name.
 Shared preventive measure ideas.
 Show and tell for preventive and treatment supplies.
 Rep demo tables with available products.
 Provide one number to call for all concerns for new
admissions that came from HMC.
One Phone Number

706-754-3113 Ext: 1121
 This one step was the one step we took that really
made a difference.
 Gave us real data on pressure ulcers.
 Gave HMC real time information to review the
patient’s care to see what we could have done
differently.
 Learned from our lost opportunities.
 Peer pressure knowing that everyone was looking,
reporting, and reviewing.
Formulated Our Team
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Physical Therapy
Acute Care Nursing (Med/Surg, ICU, OR)
Material Management
Infection Prevention
Information Technology
Long Term Care Nursing
Home Health Administration
Hospital Administration
Medical Staff to include:
 Orthopedics & General Surgery
Started In The Basement…

 Infection Prevention and Material Management
leaders took inventory of all skin prevention and
treatment products stocked for all areas.
 Reviewed our contracted options.
 Contracted companies and trialed products in LTC.
 Completed cost analysis on products; contract vs.
non contract products.
 Approved products and educated staff and Medical
Staff.
Worksheet for Testing Change
GOAL:
(Overall goal you would like to reach)
Every goal will required multiple smaller tests of change
Worksheet for Testing Change
Describe your first (or next) test of change
Plan

List the tasks needed to set up this test of change
Person
Responsible
When to be
done
Where to be
done
Person
Responsible
When to be
done
Where to be
done
1.
2.
3.
4.
5.
Predict what will happen when the test is carried out
1.
2.
3.
4.
Measures to determine if prediction succeeds
1.
2.
3.
4.
Do
Describe what actually happened when you ran the test of change
Study
Describe the measured results and how they compare to the predicted results
Act
Describe what changes to the plan will be made for the next cycle from what you learned
s material was prepared by Alliant | GMCF, the Medicare Quality Improvement Organization for Georgia, under
ntract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and
man Services. The contents presented do not necessarily reflect CMS policy. Publication No. 10SOW-GA-IIPC-11-51
GOAL- Evaluate Products

Step One…
Describe your first (or next) test of change
Person
Responsible
Infection
1. Evaluate current products available and Prevention &
newer products on contract for potential
Material
use.
Management
When to
be done
August
2009
Where to be
done
Material
Management
Department
Step Two

List the tasks needed to set up this test of
change
1.
2.
3.
4.
5.
6.
Schedule time to meet together
Collect all skin products
Contact Company for Product Review
Complete cost analysis for preferred
products requested.
Present cost analysis to Administration for
approval.
Take approval products to Wound Care Team
with Names and Indications
Person
Responsible
When to be
done
Where to be
done
IP
MMT
MMT
IP
End of week 1
August 20th
August 20th
September 1st
Via Outlook
Department
MMT
IP
IP
September 8th
Administration
MMT
September
10th
Wound Care Mtg.
in September ‘09
Step Three

Predict what will happen when the test is
carried out
1.
Measures to determine if prediction
succeeds
LTC would reduce pressure ulceration
1. LTC monitored pressure ulcers with
with a non-contract product
the “butt cream” vs. other product.
2. Education on all stocked products
2. Completed Library on Skin Products
3. Medical Staff would need to be educated
with all Products, Indications, and
on products.
“How To Use” Instructions was a win
for staff satisfaction.
3. Presentation to Medical Staff on
products and how to located
information on products.
Step Four

 DO:
 Describe what actually happened when you ran the test of
change.
 Clear understanding of products stocked and how to use
them.
 Medical Staff educated for the need of documentation for
pressure ulcers overall, to include POA.
 Medical Staff educated on products stocked and how to use
them.
 Trialed different heel boots with no success.
Step Five

 STUDY:
 Describe the measured results and how they compare to
the predicted results.
 Staff accepted the change of culture and appreciated the
team clearing the confusion related to products.
 Medical Staff struggled with the culture change focusing
on skin and the importance of documentation and
assuring the proper products were being used on the
patients.
 Unexpected barrier with “Boots” to protect the heels.
Trials multiple products that took 18 months to finalize
the preferred product.
Step Six

 ACT Describe what changes to the plan will be made for the next cycle
from what you learned
 Continue to monitor or someone will change it without you knowing
it…
 Set expectations and follow them closely.
 Share the responsibility so all team members are engaged.
 It is not what you expect as much as what you inspect.
Products was just
one change

Continue to monitor outcomes until
you find your facilities solution
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Community Skin
Evaluation Assessment
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 Tallulah Falls Community Meeting
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Braden Scale
Staging of ulcerations
Flow chart different terminology of ulceration
Understanding why certain facilities use different
scales and terms.
Talking the same talk!
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Friction
Injury
Stage II
Pressure
Ulcer
Skin Tear
Partial
Thickness
Burn
Wound Rounds
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 Long Term Care implemented weekly Wound
Rounds to include Nursing, Physical Therapy, and
Medical Staff.
 Implemented Acute Care Wound Rounds Started small on one unit, Surgical Unit one day a
week at the same time with PT and Nursing
 Added ICU to Wound Rounds on Wednesday
mornings at 0800.
 Graduated to doing Wound Rounds weekly on all
units.
Wound Education

 Annual wound education for all clinical staff.
 Demonstrate products and evaluate the staffs
knowledge of proper use.
 Creative games using scavenger hunt approach.
 Convetec and Medline Reps available to answer
questions for products.
 Chained wound booklets to each nursing area as a
reference
 Provided Pressure Point Pocket Cards from GMCF
Sometimes the problem is
bigger than you can fix!

 Remembering to stick to the basics before
progressing is difficult. We always want to fix
everything at once.
 Remember time is on your side…
 How did our Long Term Care facilities get to zero
doing the same things Acute Care is doing?
Get them out of bed!
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Administrative
Involvement

 Don’t assume they know what you need.
 Make sure they understand the financial impact and
most importantly the impact it has on the patient’s
outcome.
 Replaced chairs in patient rooms.
 Replaced mattresses and beds.
In addition

 Hourly Rounding.
 Annual Nursing Tech Education to include pressure
ulcer prevention.
 Wound Vac Certification for Nursing.
 Adding POA to our morning rounds with Medical
Staff.
 Revised documentation in Meditech 6.0 for Wounds
 Deleted all TED Hose facility wide.
In conclusion…
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 HMC has eliminated HAC Pressure Ulcerations for nine
months.
 Evaluate documentation and preventive measures taken
on each call received from community.
 Use information to continued education.
 Provide referred facilities with review findings.
 Last known pressure ulcer was August 2011 from a
device placed on the patient’s leg. Reviewed the product
and usage with Medical Staff and employees.
 Take the time and opportunity to learn from your
reviews.
The End
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