Best Practices in Home Care:
Pressure Ulcer Prevention
Background of the Pressure Ulcer
Prevention Initiative
• The importance of quality in wound management has
never been greater with the implementation of OASIS C.
• Since the Fall of 2011, a total of four wound-associated
items, three of which are related to Pressure Ulcers, have
been publicly reported on the Home Health Compare
Website.
• Utilizing the Home Health Compare website, CMS is
informing healthcare consumers of homecare agencies
that conduct pressure ulcer risk assessment,
communicate with physicians to obtain orders for pressure
ulcer prevention and implement measures to reduce the
development of pressure ulcers.
Pressure Ulcers Incidence in St.
Luke’s Home Health Patients
 Higher incidence of Increase in the Number
of Pressure Ulcers
 Chart audits revealed
Pressure ulcers possibly missed at SOC
Other wound etiologies mistakenly labeled as
pressure ulcers
Inconsistent documentation of interventions for
patients determined to be at risk based on the
Braden Scale
VNA of St. Luke's
Increase in Number of Pressure Ulcers
January 2006 - June 2009
Source CASPER
2.50%
2.00%
1.50%
1.00%
0.50%
0.00%
Qtr 3
2005
Qtr 4
2005
Qtr 1
2006
Qtr 2
2006
Qtr 3
2006
Qtr 4
2006
Qtr 1
2007
Qtr 2
2007
Qtr 3
2007
Qtr 4
2007
Qtr 1
2008
Qtr 2
2008
Qtr 3
2008
Qtr 4
2008
Qtr 1
2009
Qtr 2
2009
VNA
1.32%
1.39%
1.07%
1.82%
0.72%
1.02%
1.28%
1.45%
0.61%
2.05%
1.15%
1.31%
0.89%
0.71%
1.00%
1.22%
Reference
1.00%
0.94%
0.96%
0.94%
0.92%
0.87%
0.88%
0.86%
0.86%
0.84%
0.85%
0.81%
0.81%
0.76%
0.81%
0.77%
Problem
The VNA of St. Luke’s Home Health patients
experienced a higher incidence of developing
pressure ulcers compared to the national
reference
Aim
The VNA of St. Luke’s Home Health incidence
of pressure ulcers will be lower than the
national reference by April 2010
Our PI Team
 Two Wound Care Certified
RN’s
 One Home Health RN
 One Physical Therapist
 Home Health Quality
Manager
 Home Health and Network
Hospital Leadership
Our Plan…
 Develop a comprehensive pressure ulcer prevention
program that targets multiple factors that contribute to
pressure ulcer formation
 Develop script for clinicians to use with patients to explain
importance of head to toe skin assessment
 Devise a consistent process when instructing patients on measures
to prevent pressure ulcers including use of a skin care product
 Add prompts related to pressure ulcer prevention to OASIS to
remind clinicians to educate patients at risk and to facilitate ease of
documentation
 Create resource tools containing pictures of pressure ulcers at
various stages and guidance for OASIS M questions related to
pressure ulcers
 Educate staff through a train the trainer process based on
clinician’s perceived need
Do…
 Process
 Patients with a Braden Score of 18 or less received a free
prevention product
• Purple cap for patients with “pretty” skin
• Blue cap for patients in need of a “barrier” due to moist skin
 Added check off boxes to OASIS to prompt clinicians to provide
education patients at risk and to facilitate ease of documentation
 Product
 Provided patients with a tangible product and had staff “show and
tell” about the product’s use lending credence to the importance of
skin care
Do. . .
 Pictures
Developed resource tools containing pictures of
pressure ulcers at various stages and CMS
guidance on answer pressure ulcer M questions
on OASIS
 People
Added teaching handout on pressure ulcer
prevention to each admission packet
Evaluated staff’s perceived knowledge of
pressure ulcer staging, prevention and product
use as well as their ability to document OASIS C
responses using a survey tool
Phase 3: CHECK
VNA of St. Luke's
Increase in Number of Pressure Ulcers
January 2006 - September 2010
Sources: CASPER/OCS
2.50%
2.00%
1.50%
1.00%
0.50%
0.00%
VNA
Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3
2005 2005 2006 2006 2006 2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010
1.32% 1.39% 1.07% 1.82% 0.72% 1.02% 1.28% 1.45% 0.61% 2.05% 1.15% 1.31% 0.89% 0.71% 1.00% 1.22% 0.13% 0.68% 0.40% 0.10% 0.10%
Reference 1.00% 0.94% 0.96% 0.94% 0.92% 0.87% 0.88% 0.86% 0.86% 0.84% 0.85% 0.81% 0.81% 0.76% 0.81% 0.77% 0.75% 0.72%
0.80% 0.40%
Phase 4: ACT
 Develop and distribute body map containing
location sites to promote consistent wound
labeling
 Develop and distribute wound product resource
tool that describes product purpose and use for
wounds of various etiologies including
pressure ulcers
Questions…
VNA
Mission
The Visiting Nurse Association of St. Luke’s, as part
of the St. Luke’s Hospital & Health Network, will
provide compassionate, excellent quality, cost
effective home health care, hospice services and
home based parent/child programs.
Vision
The Visiting Nurse Association of St. Luke’s will be
the Leader in Community Based Healthcare.