SE1EOb

 

Interprofessional Care SE1EO

 

Using the required EO presentation format, provide an example, from an ambulatory care setting, of an improved patient outcome associated with the participation of clinical nurse(s) serving as a member(s) of an organization-level interprofessional decision-making group. 

 

 

Example b: CHI St. Vincent Hot Springs Organization-level Skin Tear Committee

Problem

From February to April 2022, Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) procedural patients experienced a high number of skin tears.

 

Pre-Intervention

The CHI SVHS procedural care areas’ skin tear rate was 1.36 for February-April 2022 (three months). Prior to February 2022, the procedural areas had focused on preventing pressure ulcers during long procedures. Patients are generally under some type of sedation or general anesthesia and depend on the procedural staff member to protect all areas, including skin, during procedures. Based on the increase in skin tear injuries in the perioperative phases of care, leadership from the procedural areas encouraged Tim Lambeth, BSN, RN, Nurse Manager, Operating Room (OR)/Sterile Procedure Department (SPD), and procedural coworkers to research best practices for reducing preventable skin injuries to improve patient outcomes.

 

Goal Statement

To reduce the rate of skin tears for CHI SVHS patients in the procedural care areas.

 

Participants

 

Interprofessional Procedural Skin Tears Committee
Name/Credentials	Discipline	Title/Role	Department
Tonya Baier, BSN, RN	Nursing	Clinical Director of Nursing/Sponsor	Nursing Administration
Tim Lambeth, BSN, RN	Nursing	Nurse Manager/ Team Leader	Operating Room, Sterile Procedure Department
Kimberly Dawn Spurlock, BSN, RN	Nursing	Nurse Manager	Outpatient Services
Diane Pate, BS	Quality	Six Sigma, Quality Analyst, Performance Excellence	Quality
Laura Rasmussen, RN	Nursing	Patient Care Coordinator, Clinical Nurse	Operating Room
Sabrina Ferguson, TS-C	Surgical Technology	Specialty Surgical Technician	Operating Room
Melissa Entrician, BSN, RN	Nursing	Clinical Nurse	Operating Room
Kathryn Goad, BSN, RN	Nursing	Patient Safety Mgr.	Risk Management
Jennifer Haus, BSN, RN	Nursing	Clinical Nurse	Endoscopy Lab

 

Description of the Interventions
May 2022
Lambeth participated in the CHI SVHS Lean Project Training. As part of the training, Lambeth led an interprofessional, organization-level decision-making group with responsibility for reviewing skin tear data, performing research, establishing evidence-based practice, and making decisions about ways to decrease patient skin tears.

June 2022
Lambeth organized a Procedural Skin Tears Committee and led its first meeting on June 16, 2022. Attendees included clinical nurse and surgical scrub tech champions Laura Rasmussen, RN; Sabrina Ferguson, TS-C; Melissa Entrician, BSN, RN; Jennifer Haus, BSN, RN; and Kimberly Dawn Spurlock, BSN, RN, Outpatient Services Manager. Clinical nurses and scrub techs from procedural areas (OR, endoscopy lab, and outpatient) serve as champions to create awareness.

 

Lambeth recommended that the committee be interprofessional, incorporating key stakeholders who participate in the care of procedural patients. The expertise of interprofessional stakeholders would be needed to identify root causes and barriers and to assess the needs of patients and coworkers to ensure improvement in patient outcomes. During the Procedural Skin Tears Committee’s first meeting, they identified two areas that needed to be addressed: a lack of staff education and the need for product resources to care for high-risk patients The Lean Project Team supported the committee during this meeting, and the group discussed the committee’s responsibilities:

• Identifying root causes, opportunities, and barriers to reducing skin tear injuries
• Monitoring trends in skin tear prevention processes, skin tear rates, and sentinel events
• Communicating and collaborating with other groups and key stakeholders
• Recommending improvement initiatives for skin tear prevention in accordance with evidence-based practices
• Evaluating all skin tear-related initiatives as appropriate
• Identifying and evaluating appropriate equipment used for positioning and transferring patients

 

Clinical Director Tonya Baier, BSN, RN, Clinical Director of Nursing, serves as the sponsor of the Procedural Skin Tears Committee, which reports to the Executive Performance Improvement and Patient Safety Committee (PIPSC). The Executive PIPSC is the highest-level interprofessional decision-making group for the market (CHI SVHS, CHI St. Vincent Infirmary, CHI St. Vincent Morrilton, and CHI St. Vincent North) and makes quality-related decisions.

The Procedural Skin Tears Committee met again on June 21, 2022. Champions Haus, Rasmussen, Ferguson, and Entrician assessed the department’s needs, supplies that were needed, best practice for positioning patients, documentation, and handoff report for procedural patients. After assessing the needs of procedural coworkers during the previous week, the committee developed a plan for education on skin tears and identified appropriate supplies to prevent skin tears.

 

• Education
  • Preoperative skin assessment
  • Identification of high-risk patients
  • Documentation of skin condition and wounds
  • Handoff report to include findings
  • Taping supplies available for anesthesia providers
  • Positioning supplies available to protect at-risk patients
  • Skin assessment and skin tear education added to Competency Based Orientation for new coworkers
• Supplies
  • ProTouch Cotton Stockinette
  • Laminectomy Arm Cradle Foam Positioner
  • Kind Remove Silk Tape
  • Allevyn Life

 

Haus worked with Materials to ensure the necessary supplies were added to the preoperative and endoscopy areas’ supply carts. Rasmussen, Ferguson, and Entrician worked with the OR Materials lead to ensure stockinette, arm cradle positioners, silk tape, and Allevyn life supplies were available and easily accessible in the OR suites for positioning patients and protecting their skin. Lambeth and Spurlock provided skin tear education to all coworkers as the monthly education topic during monthly unit meetings.

 

July 2022
Lambeth and Spurlock implemented staff education as part of daily unit-based safety huddles. It covered at-risk populations, skin assessment, handoff reports for high-risk patients, taping and positioning supplies, and documentation of action. Lambeth and Spurlock also used these huddles to discuss the use of appropriate tape and how to wrap arms and/or use foam padding on high-risk patients.

 

On July 12, 2022, Lambeth and Spurlock reviewed the skin tear plan with the anesthesia team to ensure the CRNAs were aware of the plan for assessment, taping, and positioning of patients to protect their skin from injury.

 

Skin Tear Champions Ferguson, Entrician, and Rasmussen circulated in the OR to educate teams on the importance of skin assessments, high-risk patients, handoff report with the preoperative team, location of supplies, and positioning of patients using the tools. Haus educated the perioperative and endoscopy nurses on the positioning of patients preoperatively and prior to ERCP procedures. Haus also educated the team on the supplies that had been added and the importance of using the Allevyn Life padding, silk tape, and Laminectomy arm cradles for high-risk patients. Haus ensured the areas have slide boards available for transferring patients between beds.

 

On July 30, 2022, Lambeth and Spurlock reviewed skin tear interventions with procedural coworkers as the monthly education topic during the monthly unit meetings.

 

The interventions were fully implemented by the end of July 2022.

 

Clinical nurses serving as members of an organization-level, interprofessional decision-making group was associated with a decrease in the rate of CHI SVHS procedural care area skin tears.

 

References

Holmes, R., Davidson, M., Thompson, B., & Kelechi, T. (2013). Skin Tears Care and Management of the Older Adult at Home. Home Healthcare Nurse, 31(2), 101–103. https://doi.org/10.1097/nhh.0b013e318285c7d0

 

LeBlanc, K., Campbell, K., Beeckman, D., Dunk, A., Harley, C., Hevia, H., Holloway, S., Idensohn, P., Langemo, D., Ousey, K., Romanelli, M., Vuagnat, H., Woo, K., Ayello, E., Baranoski, S., Bianchi, J., Carville, K., Christensen, D., Edwards, K.,… Williams, A. (2018). (PDF) The prevention and treatment of skin tears. ISTAP Best Practice Recommendations.

 

Outcome

(Evidence SE1EOb-1, Rate of Skin Tears Graph)