Greenfield Health and Rehabilitation Center in Lancaster, New York, has been working with IPRO as an Identified Participant in the Nursing Home Quality Initiative.
In 2003Q3, Greenfield's High Risk Pressure Ulcer Quality Measure was at 30.7%, higher than the state and national averages. By 2005Q4, the facility's High Risk Pressure Ulcer Quality Measure was 10.3% -- a significant improvement that brings the facility's percentage lower than the state and national averages.
Greenfield's skin assessment team has worked hard and "worked smart" to reduce the number of skin issues at the facility. An important undertaking was conducting regular assessments by a team of nurse managers, staff nurses, and dietary personnel. The Unit Coordinator was paired with an RN who conducts weekly skin rounds with the team.
The team reinforced its message by displaying skin-issue posters on all units and in the facility's classroom. The posters raise awareness; staff members ask questions and demonstrate interest in learning more about skin issues. To ensure a standard method of evaluation, the team incorporated the Braden Plus Scale for skin assessment of resident's risk for skin breakdown. The team also developed a series of new forms, including an internal skin assessment form, dermal sheet, and the PUSH Tool to monitor wound healing.
The team also got CNAs involved in the prevention and treatment of pressure ulcers. They developed a "Red Alert" sheet, completed by the CNA, that brings potential problems to the nursing staff's attention sooner. Each week, the team meets regarding dermals and weights (as the two go hand in hand) to increase operational efficiency. The team consists of Diet Technicians, a Registered Dietician, the Administrator, the Director of Nursing, the Assistant Director of Nursing, the Quality Assurance Nurse, and all RN Unit Coordinators. All skin issues are on the table as the team collaborates. The team ensures that dermal tracking books are kept at each unit for staff members' reference. In addition, "turn and post" reminders on the back of all nursing staff badges are standard.