A few weeks ago, we brought the nurses together on the transitional care unit (TCU) to talk about our process related to complete the Braden Scale for Predicting Pressure Ulcer Risk for our residents and next steps. Though these nurses are busy, they’re finding time to complete the Braden Scale for all residents. However, it isn’t clear to them who should follow up to make the necessary changes to the care plan once the assessments are complete. The TCU nurses had some great ideas for changing the process.
Recently, many of us listened to a Plan, Do, Study, Act (PDSA) webinar. We thought it would be a good idea to trial the new process on the TCU to get the bugs worked out before going facility-wide. It’s been two weeks and today our interdisciplinary team met to discuss how it’s going. There was a lot of feedback about this new process!
1. Include a list of evidence-based pressure ulcer prevention interventions for each risk factor on the back of the Braden Scale form that relates to the identified risks. Judy, our assistant director of nursing, agreed to put this together.
The nurses felt this step was double work. They thought it would be more helpful if we had a pressure ulcer care plan template including the list of interventions. Each time the Braden Scale is done, they can grab the pressure ulcer care plan template, or add to the one already in the health care record, and check off the appropriate interventions. Great idea for eliminating them having to do this twice!
2. The nurse completing the Braden Scale each week will check off which interventions to implement, ensure that any equipment needed and/or consults are in place, and update the care plan by the end of the shift. She’ll inform the health unit coordinator (HUC) of the changes.
The dietary and therapy departments aren’t available 24/7, so it isn’t always possible to get a consult completed by the end of every shift. So, the dietician will come up with a list of high protein, high calorie snacks and make those available in all of the kitchens. Staff will offer these snacks to high-risk residents twice a day until the dietary consult is done. We’re meeting with the therapy manager later this week to develop a plan for those consults.
3. The HUC will make changes to the NA assignment sheets and the nurse will make changes to the care plan by the end of the admission shift, or when a change of condition is recognized.
The assignment sheets are not always getting updated since a HUC isn’t available every day and shift. So, the nurse will need to be responsible for this step too, though she can delegate it if the HUC is available. We might be able to simplify this somehow through the electronic medical record. I need to set up a time to talk to our vendor about this.
The plan is to trial these changes on the TCU for two weeks and see if the team is better able to follow through on pressure ulcer risks identified on the Braden Scale. Once we get this process down, we’ll implement it in all of our neighborhoods. This has been a great exercise in using PDSA to test process changes! I wonder what other process changes nursing homes are putting into place to prevent pressure ulcers?