PDSA

The medical/surgical staff at Fontana Medical Center had a problem with pressure ulcers. The 59-bed unit averaged about 10 of these hospital-acquired bed sores a quarter.

It's painful for the patient and costly for the hospital, which can average about $43,000 per incident. But pressure ulcers are also preventable, and that can lead to shorter hospital stays and improved patient satisfaction scores. Reducing the rate of pressure ulcers can also eliminate inquiries from the California Department of Health Services.

Based on recommendations from the UBT, the staff implemented an education program and provided one-on-one training on how to spot, rate and reduce bed sores.

The team established a strict regimen that included rating patients on the Braden Scale, which helps identify those at risk for pressure ulcers. They performed morning assessments, and used waffle mattresses and moisture-protective barriers for at-risk patients.

They also rounded hourly for turning and got patients out of bed three or four times a day to decrease their risks. This allowed patients to use the restroom and to keep them clean.

“It’s pretty much a collaborative effort among nurses, nutritionists and wound specialists,” says charge nurse and UBT co-lead Toni Leonen. “The nurses are receptive to implementing the various methods we use to prevent pressure ulcers.”

In a span of two years, the new process helped the team reduce the number of bed sores to 0.

“We’ve created this environment where the staff thinks safety and thinks patient comfort,” Kathy Smith, RN, assistant department administrator says. “It’s automatic. They just come in and make sure patients are turned. Nobody has to remind them.”

Coming up with a new process to combat pressure ulcers helped the team build a sense of unity and staff satisfaction, but they also know the work continues.

“Sustaining our success is the biggest challenge because you can revert back to old practices,” Smith says. “You have to keep emphasizing what we’re doing and what the reasons are. Make sure they know you appreciate them so they continue to do well.”

Colorado’s asthma care coordinators discovered that children were refilling their medications at the lowest rate in the region. The group works alongside physicians and staff to provide education and outreach to Kaiser Permanente members with asthma or chronic obstructive pulmonary disease.

Inhaled corticosteroids help control asthma by reducing inflammation and mucus production. Asthmatics who use the meds daily experience fewer attacks, use their emergency medicine less and make fewer visits to the emergency room.

There are some common threads among patients, who don’t refill their prescriptions. These include the costliness of inhalers, the fact some patients are reluctant to take a steroid, and often patients stop medication when they start to feel better.

“It took us a while to identify the most important thing our UBT could do,” said Cindy Lamb, RN, an asthma care coordinator and member of UFCW Local 7. “It was definitely a learning process.”

So, the asthma coordinators decided to improve the refill rate through an outreach program and targeted members ages 5-17. They made phone calls to five members a week who had not refilled their prescriptions in more than four months. As part of the discussion they included talking points about the benefits of inhaled corticosteroids. They used trackers and scoreboards to monitor the outreach and keep everyone informed.

The seven asthma care coordinators were spread throughout the region, so they held weekly phone huddles to share progress and best practices. They highlighted the convenience of the mail order pharmacy, and provided members with prescription refill numbers as well as the telephone number to the pharmacy. This information helped patients refill their medications more promptly.

The team also had communicated regularly with pediatric physicians and other staff by phone, conversations, meetings, and email.

None of it happened overnight, but the team discovered the collaborative effort really helped the process. In all, they reached 1,100 patients.

“Give the process the time it needs,” said Asthma Care Coordination manager Leah Brines. “Resist the temptation to come up with solutions for the team and instead, guide the conversation, and encourage participation and discovery. The team, given the time and confidence, will find the solution.”