In the last issue of Strengthening Bridges, we presented an overview of the quality measures throughout PCC, with a focus on the IRF, LTAC and Home Care measures.

This issue presents information on two important quality measures for SNF facilities, Fall Rates and Hospital Acquired Pressure Ulcers. We are pleased to report that the PCC SNF facilities, The Boston Center and North End, have steadily decreased both rates over the last 2 years as a result of improvement initiatives put into place by clinical teams.

Fall rates have shown a nearly steady decline since CY'08 in each of the facilities. _________________________________________________________________________________________

Fall Rate per 1000 Resident Days

North End Rehabilitation CY '08-3.99 CY '09-3.50 CY '10*-3.23

Boston Center CY '08-6.60 CY '09-4.41 CY '10*-4.27

* through March 2010 ________________________________________________________________________________________

Some of the initiatives put in place that have been instrumental in this decline include:

- Daily review of falls by leadership at morning meetings

- Weekly interdisciplinary fall rounds on each of the nursing units during change of shift to maximize staff involvement. These rounds are instrumental in identifying and implementing fall prevention strategies

- Implementation of Falls Teams to review trends of resident falls

- New patient education tool containing information on how to prevent falls and stay safe while in the hospital as well as at home after discharge. This tool is reviewed with each resident within the first 2 days of a patients stay.

- Purchase of additional equipment which aids in the residents positioning both in wheelchairs and in bed to minimize the risk of falling

- Ongoing education of staff in fall prevention strategies and use of equipment

Another important measure in skilled nursing facilities is the rate of hospital-acquired pressure ulcers. ________________________________________________________________________________________________

Hospital Acquired Pressure Ulcer Rate Per 1000 Resident Days (Excludes Stage I)

North End Rehabilitation CY 08-0.46 CY 09-0.19 CY 10*-0.08

Boston Center CY 08-0.70 CY 09-1.42** CY 10*-0.00

* through March 2010

** Increase due to method of tracking ulcers, i.e. # of patients vs. # of ulcers prior to 10/09 ________________________________________________________________________________________________

Some of the initiatives put in place responsible for the decline in hospital acquired pressure ulcer rates include:

- SKRH Wound Nurse provided training for licensed staff on skin assessment.

- Skin consultations provided by SKRH Wound Nurse.

- Adoption of weekly skin rounds on each resident.

- Implementation of wound databases to analyze trending.

- Staff education and competencies are being standardized using the Medline Pressure Ulcer Prevention Program. At the North End Rehab, 42 nurses and 67 aides have completed the training.