Nursing Homes in New York and throughout the nation are experiencing sluggish improvement in the pressure ulcer quality measure rates and gaps in the coordination of care across the health care settings. Lack of communication and/or adequate communication across settings is a common barrier for clinical teams with respect to continuity of care, prevention, and treatment of residents at risk for developing pressure ulcers.
In an attempt to facilitate improved communication across health care settings, IPRO convened a cross setting statewide task force consisting of representatives from nursing homes, hospitals, home health agencies, the New York State Department of Health (NYS DOH) and clinical experts in pressure ulcer care. Emerging from this task force was the concept of a regional demonstration project, focusing on communication across health care settings. The Pilot was a collaboration of IPRO and Inter-County Health Facilities Association and Nassau - Suffolk Health Council.
In the spirit of collaboration, it was decided that IPRO will use the Long Island (LI) region as the site for the demonstration project. All of the health care entities serving the LI region were invited to participate in this groundbreaking initiative. The use of a regional transfer agreement was a central component of the project, along with the distribution of clinical and quality improvement tools (including a data tracking tool).
Throughout the pilot project an agreed upon Skin Care Information data set form was expected to be forwarded to the receiving facility with every resident transfer. The receiving facility was expected to document the information on a standardized Pressure Ulcer Communication Form.
(Each facility used the common Braden Scale to assess Pressure Ulcer Risk)
The Demonstration Project measured outcomes and communication improvement across health care settings. Each communication item had the numerator, denominator and percent of successful communication noted; an aggregate report displaying each communication element and its percentage of successful communication was shared with all collaborators.
Looking at the bigger picture, the pilot brought participant discussions to a national forum, namely the National Pressure Ulcer Advisory Panel (NPUAP). Topics such as staging of serous or sanguineous filled blisters, discerning pressure ulcers from friction bullae, and the Kennedy terminal ulcer were discussed within the group, with input from pressure ulcer experts. The pilot project itself brought positive attention to the LI region from NYS DOH officials, and was mentioned at the 2007 NPUAP biennial conference in San Antonio.