Addressing Barriers

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Addressing Barriers

• Denise Nix RN, MS, CWOCN
• Associate Director
• webWOC Nursing Educational Program

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Barriers

• Communication
• Knowledge Deficit
• Technical Components
• Patient Complexity
• Staffing Work Management
• Measurement
• Patient Noncompliance

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Barriers

• Communication Gap
• Caregivers and Management
• Caregivers and Physicians
• Caregivers and Patients/families
• Between Units and Care Settings
• Whos Accountable for What?

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Barriers

• Knowledge Deficit
• Impact of Pressure Ulcers
• Identification of Stage I
• Pressure Ulcer Progression
• Sitting Surface Wounds
• Conflicting Information

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Barriers

• Technical Components
• Equipment and Procedures and Not Available
• Equipment Is Slow to Arrive
• Lack of Standardization of Procedures and
  Equipment

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Barriers

• Patient Complexity
• Aging Population
• Multiple diseases
• Polypharmacy
• Immune Suppressed
• Increase Obesity
• Noncompliance

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Barriers
Staffing
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Actions

• Time Saving Strategies
• Incorporate Interventions Into Already
  Established Routines

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Actions

• Time Saving Strategies
• Standardize Protocols
• Provide Decision Making Tools

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Actions

• Enhance Product Acceptability
• Staff input
• Education, Education, Education

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Actions

• Standardize
• Pressure Ulcer Risk Assessment
• Prevention Standing Orders
• Equipment and products
• Skin Care Teams

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Actions

• Decision Making Tools
• Bed Algorithms
• Flow Charts
• Conversions Charts
• Skin Care Teams

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Team Approach
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Actions

• Education
• Impact and Significance
• Assessment Protocol
• Prevention Protocol
• Documentation
• Evidence based practice
• Legally defensible practice

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Actions

• Identify key stakeholders
• Administration
• Nursing
• Rehabilitation (PT, OT, RD)
• Utilization Review
• Social Services
• Materials Management
• Unit Champions (for Skin Care Teams)

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Actions

• Pressure Ulcer Tool Kit
• (www.ICSI.org/knowledge)
• Checklist for Documentation
• Nursing Standard of Care (Sample)
• Nursing Care Plan
• Bed Algorithm
• Prevention Brochure
• Positioning Guide

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Measurement

• Discharge Audit Questionnaires
• Discharge Skin Assessments
• Prevalence/Incidence Studies(wocn.org)

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Barriers
Noncompliant
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Its a problem...

• Impact of Nonadherence
• (Medications only Durso, 2001)
• 100 billion lost annually for health care and
  loss of productivity
• 50 of medications are never picked up
• 8.5 billion in preventable clinic visits and
  hospitalizations

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Perceptions

• Hallett et al, 2000
• 62 Community Nurses surveyed about wound care
• Listed noncompliance as most frustrating aspect
  of wound care
• Definitions of noncompliance
• Passive resistance and lack of motivation
• Overt refusal and deliberate interference with
  care

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Perceptions of nonadherence
This patient wont
I dont understand! Why is this important? I
cant
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Knowledge Deficit (So et al, 2003)

• 50 information is LOST immediately after
  speaking with a health professional

• Explain consequences
• Use multimedia

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• Cognitive Impairment

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• Depression
• (National Institute of Mental Health)
• 18.8 million
• 9.5 of the population at any given time
• up to 80 are untreated or undiagnosed

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• Impaired
• Mobility

Lack of Resources
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Complicated regimens
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Actions

• Team approach
• Encourage Memory Aides
• Enlist the help of family and friends

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Evidence-Based PracticeDiCenso et al, 2005

• Identification and consideration of
• PATIENT PREFERENCES AND ACTIONS ARE CENTRAL
• to evidence based decision making

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Adjust the spotlight!
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Set mutual goals
Sustainable Plan
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Thank you

• Denise Nix RN, MS, CWOCN
• Associate Director
• webWOC Nursing Educational Program
• dnix_at_mn.rr.com