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Quarterly care planning meetings often include the resident or designated representative (when they can attend), caregiver and interdisciplinary team members. Many of our residents have various wounds, other than due to pressure. Residents with arterial/ venous insufficiency (peripheral vascular disease/ stasis ulcers), diabetic, or surgical wounds are younger than the population with pressure ulcers. Utilization of a local hospital’s wound center for vascular, diabetic and surgical wounds are made when pertinent to diagnosing or evaluating treatment options. Management of these other wounds are more challenging as residents often do not wish to raise legs, wear special hose, follow diets, or have dressing changed, per physician orders for frequency. This mixed population demands weekly education with physician present. Important considerations include residents’ mental competency, danger to self or others with refusal, prior life style preferences and resident’s goals and objectives for his/ her health and happiness. The team feels that appropriate care is a balance between what is needed and safe versus individual rights and preferences. Mitigating Risk Factors The comprehensive care plan is established to include risk, skin break reasons, resident’s strengths or weaknesses, goals, time frames, measurable objectives, interventions and periodic evaluations. Care plans must mitigate and lower risk factors that support appropriate interventions (e.g. - high risk due to immobility might lead to interventions that include (not limited to) exercise rehabilitation program, turning and repositioning, and/ or toileting schedule. The team monitors plan for needed change at least quarterly (and more often to add or delete interventions). Outcome of the pressure ulcer healing progress is noted. A high percent (above 98%) of residents with pressure ulcer were admitted with their skin breaks. The skin care team concentrated more on the risk factors and healing rates rather than the quality indicators of high risk pressure ulcers. Outcomes Realized 1. Rates for high-risk pressure ulcers: Year Observed Percent Range Monthly Average 2007 From 57% to 0% 22% 2008 From 50% to 8.3% 30% 2009 From 30% to 0% 15% (thus far, 10 months) 2. Healing rates: Year Observed Range Monthly Average 2007 Not measured consistently Unable to determine 2008 From 7 to 0 1.8 2009 From 7 to 1 3.9 In 2007 the new program was created and its implementation depended on proper recruitment and much education. The healing average per month increased from 1.8 to 3.9 over the two-year span. This calculates to an average of 2.1 more pressure ulcers that were healed each month of 2009 compared to 2008. In 2009, both units had improvements in healing rates and both units won awards for pressure ulcer healing rates.
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