Needs/Resource Assessment: Complicated Pressure Ulcers

Survey previous or ongoing efforts and resources

In many ways a multidisciplinary QI team is building, flying, and navigating an aircraft that is already airborne. Therefore it pays to know exactly what resources or circumstances are already available. Experience, precedents, or skilled individuals can significantly lift an effort. Conversely, working at odds with infrastructure or strategic goals can sabotage everything.

Each of the items below could affect the approach to this improvement effort. These items can influence interventions and the performance tracking system. The QI team should find the answers to these questions. 

1. What is the existing quality improvement infrastructure? What support or services are available for this project?
2. Are there any ongoing quality improvement initiatives to learn from or leverage?
3. Are there any initiatives that could influence support for a complicated pressure ulcer prevention effort: e.g.  In 2008 CMS announced as of October 2008 it will no longer pay for stage III or stage IV pressure ulcers acquired during a hospital stay.
4. What performance data on pressure ulcer prevention or stage III and IV events already exist?
5. Are there any major lessons from previous or ongoing interventions to prevent pressure ulcers?
6. How successful were previous pressure ulcer risk assessments and why? Were they integrated into order sets?
7. Are there ongoing pressure ulcer educational or awareness activities for medical staff?
8. How fragmented is care in the hospital? Are ICUs open or closed? Are patients geographically cohorted by service/specialty?
9. What are the existing practices for standardizing care transitions between settings, e.g. ER-to-floor, ICU-to-floor, OR-to-floor, direct admissions?
10. Can precedents be leveraged that have engaged patients in promoting medical staff accountability for any specific care goals?
11. In what areas of the hospital are nurses engaged in promoting medical staff accountability for any specific care goals, e.g. daily goals worksheet, participation in multidisciplinary rounds?
12. In what precedent-setting ways do clinical pharmacists already participate in care delivery, e.g. participation in multidisciplinary rounds, consults, pages to providers to adjust medication dosages for treatment of infections, etc?
13. Could the electronic health information or paging system relay clinical information to members of the care team: e.g. alerts by email, text page, fax, or CPOE?
14. Is there a precedent anywhere in the institution for feeding back individual (or service line) performance to providers?
15. Does the medical center have an electronic medical record? CPOE? Digital radiology?