Cross-Setting Collaborations
(Continued from page 3)
Charlotte Campbell, RN, inpatient nurse manager at Abbeville Area Medical Center, said the joint effort provided
an educational opportunity to identify common communi-
Improving Quality
(Continued from page 1)
from the nursing staff,” she said. “I was viewed as an
outsider peering in on their practice and was seen more or
less critiquing what they do. It didn’t take long for them to
see that I was there to help, not to critique.” By explaining
to the nurses her role in enhancing their care—and not being critical of their skills—Hayden was able to build a trust
with them in her ability and expertise. She broke down barriers and communicated with them in “their language and
connected with each nurse, so that after one or two patient
interactions, all of their misconceptions were dispelled.”
“There are nurses who come in on their day off to attend
educational sessions,” Hayden said. “They’ve been so receptive to what I’ve been teaching them. The State is much
more involved now than in previous years on preventing
pressure ulcers.”
In fact, with the aid of the consultants, a select group of
nursing homes have already demonstrated improvements
in their individual scores, Southard said.
cation barriers and focus on process issues between their
two facilities. “We wanted to streamline the way our two facilities were working together and identify any barriers and
obstacles to ensure we were both using the same kinds of
products,” she said.
DeRhonda Henderson, RN, assistant director of nursing at
Abbeville Nursing Home, has been instrumental in coordinating the event and engaging staff members to participate.
“Our goal will be to hold similar events like this every year
with the hospital, and eventually open it up to the public,”
Henderson said. “If the families are educated and aware
of information that can help prevent pressure ulcers before
their loved ones come to the nursing home or hospital, then
it would be worth the amount of money to treat the pressure
ulcers.”
Jean Agan, RN, certified director of nursing administration
in long term care at Abbeville Nursing Home, said both the
nursing home and the hospital are “after the same thing.”
“Avoid pressure ulcers when you can, find those pressure
ulcers when you can, be aggressive in treatment early on,
and continue those good things that begin in [either the
hospital or the nursing home],” Agan said. “The Skin Care
Fair planted a seed, and we are getting the word out better
about the importance of pressure ulcer prevention. We are
proud of the fact that we have had support from our leadership. Our successes will help us open doors for other
people and to help them achieve their own successes.”
“It’s a win-win situation,” she said. “Either the restraint
rates are going down or the wounds are healing faster, and
we’re not seeing as many facility-acquired pressure ulcers
with those facilities that have engaged in working with consultants. They achieve their goals, and we achieve ours.”
For more information, contact Theresa Seaberg at 800922-3089 or via email at tseaberg@thecarolinascenter
.org.
For more information, contact Karen Southard at 800-6822650 or via email at ksouthard@thecarolinascenter
.org.
2. Lyder CH. Pressure ulcer prevention and management. JAMA. 2003;289(2):
223–226.
1. MayoClinic.com. Bedsores (pressure sores) Complications. March 31, 2009.
http://www.mayoclinic.com/health/bedsores/DS00570/DSECTION=complications
3. Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review.
JAMA. 2006;296(8)974–984.
www.thecarolinascenter.org
100 Regency Forest Drive, Suite 200, Cary, NC 27518
800.682.2650
246 Stoneridge Drive, Suite 200, Columbia, SC 29210
800.922-3089
This material was prepared by The Carolinas Center for Medical Excellence, the Medicare Quality Improvement Organization for North and South Carolina, under contract with the Centers for Medicare
& Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 9SOW-BI-COMM-11-05
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CCME Success Stories
www.thecarolinascenter.org
PATIENT SAFETY
Improving Quality from the Outside In
By ANNA MARQUEZ COOK
CCME Creative Services Coordinator
Building trust is key in establishing a culture of resident safety in nursing homes.
P
ressure ulcers and physical restraint
use remain common challenges in
many nursing homes, yet more so in
facilities that lack the necessary resources
to achieve a culture of safety. Improperly trained nursing staff, limited budgets,
increased staff turnover, and competing
priorities are some of the factors that prevent facilities from effectively providing and
maintaining high levels of quality care. The
Carolinas Center for Medical Excellence
(CCME), a recognized leader in improving
quality care, has been working with a select
group of nursing homes and special focus
facilities and drawing on the skills of outside experts to
coach, mentor, and teach these organizations how to improve their competencies and skills in the areas of wound
care, restraint reduction, and organizational culture.
“Whatever it takes, a Quality Improvement Organization,
like CCME, can help facilities achieve their goals,” said
Karen Southard, RN, BS, MHA, a care improvement specialist at CCME. “It’s a strength on CCME’s part to have
these consultants working with us. Our mission and goals
are to mentor facilities and help them work within their
organizational structure by understanding and improving
processes to reduce the use of physical restraints and
facility-acquired pressure ulcers. A consultant offers quality
improvement tools, suggests evidence-based practices to
the facilities, and assists with integration of these strategies. In turn, it will have an overall positive impact on the
nursing home’s culture. In some circumstances, CCME
has engaged a practice consultant in either physical restraint reduction or wound care to provide the facility with
www.thecarolinascenter.org
education and best practices to help them
move to the next level.”
A practice consultant conducts onsite assessments one-on-one or with a nursing
home team. The consultants evaluate the
practices that are in place, and action plans
are developed to bring about change, improve the facility’s compliance status, and
achieve a successful culture change for the
future.
“The end goal for us is really about sustainability,” Southard said. “The nursing homes
make changes, improve their processes, and
sustain their culture of safety.”
Wound Care Specialist, Lori Hayden, RN, BSN, MHA, is
one of six consultants contracted by CCME. With a postgraduate certificate in nursing education, Hayden has
been described as “the total package” on nursing home
education and her wound care program to improve facilityacquired pressure ulcers as “outstanding.”
“Lori works with the nurses one-on-one and has leveled
the playing field between herself and them,” Southard said.
“They see her as a partner and not someone who is evaluating them. Every week, she has a different component of
education to teach the nurses on how to stage, identify,
and manage the wounds, and how to provide effective
treatments.”
Hayden describes the resistance she felt in working with
the nurses for the first time. “Initially, the guard was up
(Cont’d, See Improving Quality, page 4)
CCME Success Stories
QUALITY IMPROVEMENT
PATIENT SAFETY
Facilitating Partnerships between Patients and Their Personal
Providers
Cross-Setting Collaborations Key to Pressure Ulcer Prevention
By MAUREEN SCHWARZER, BSN, RN
CCME Electronic Health Record Consultant
Congratulations to 10 patient centered medical homes in the Carolinas for receiving
PCMH certification.
T
he Carolinas Center
for Medical Excellence
(CCME) partnered with The
Centers for Medicare & Medicaid
Services to provide an electronic
health record (EHR)-based preventive care program to a limited number of North and South
Carolina primary care physician
practices. The purpose of the
program is to improve patient care
by fully utilizing care management
functionality within the EHR. The program has specifically focused on improving care on preventive measures
including breast and colon cancer screening and flu and
pneumonia immunizations.
Wake Internal Medicine Consultants, Inc., Raleigh, NC (three
practices)
Raleigh Family Practice, Raleigh,
NC
The Family Health Centers in
Asheville, Arden, and Hominy
Valley, NC
Dr. Karen L. Smith, MD, PA, of
the Karen L. Smith practice in Raeford, NC
South Carolina
Mackey Family Practice, Lancaster, SC.
CCME assisted many participating practices by conducting onsite visits for care management assessment and
workflow redesign, as well as short cycle quality improvement projects know as Plan Do Study Act (PDSA)
cycles.
Several of the partnering practices have applied for and
received various levels of certification from the National
Committee for Quality Assurance (NCQA) for the Physician Practice Connections®–Patient Centered Medical
Home™ (PPC®-PCMH™) certification.
CCME would like to congratulate the following 10 medical practices for their PCMH certifications:
North Carolina
MAHEC Family Residency Program’s Family Health
Center, Asheville, NC
2
CCME Success Stories
“It has been our privilege to work with these practices
and help them achieve certification for the caring and
quality work they do with their patients” said Dr. Karen
Smith and Kristen Fisher, office manager for Raleigh
Family Practice, in a joint statement. Both were generous
with their kind words about the program. “The ability to
apply for the certification was, in part, from working with
the EHR consultants at CCME.”
For more information, please visit the NCQA website at
www.ncqa.org/tabid/631/Default.aspx. If you are already
participating in the CMS-QIO Prevention project, please
contact your CCME consultant for more information, or
Maureen Schwarzer, RN, BSN, CCME prevention theme
lead, at [email protected].
By ANNA MARQUEZ COOK
CCME Creative Services Coordinator
Across the street from each other in a rural part of South Carolina, two prominent
organizations are actively working together to improve care processes for the
prevention, treatment, and management of pressure ulcers in their community.
I
n a county with a population
of less than 26,000, Abbeville
Nursing Home, Inc., and Abbeville Area Medical Center serve the
same community, share the same
patients, and have the same goal—
to provide the best care possible
for the patients and residents they
serve. Although they are not corporately affiliated, they have been
collaborating for years to improve
the quality of health care they provide, and most recently
to prevent one of the most common problems facing a
large number of nursing home residents and older hospital
patients in the United States today: pressure ulcers.
Studies show that every year, about 1 million older adults,
primarily those over age 65, are affected by complications
from pressure ulcers. Life threatening infections of the skin,
muscle, or bone1 are strongly associated with mortality and
lengthy stays in the acute, post-acute, and long-term-care
settings. Incidence rates vary considerably by clinical setting, from up to 38% in acute care and up to 23.9% in long
term care.2 Costs associated with pressure ulcer treatment
exceed $11 billion in all settings.3
Theresa Seaberg, RHIT, CCS, a care improvement specialist at The Carolinas Center for Medical Excellence, said
a majority of pressure ulcers are avoidable. “By reducing
the incidence of pressure ulcers in our hospitals and nursing homes, the quality of life of the patients and residents is
greatly improved,” she said. “Ultimately, with the prevention
of pressure ulcers, harm to the patient is reduced, thereby
improving the quality of life.”
Abbeville Nursing Home and Abbeville Area Medical Center are participating providers in CCME’s Patient Safety
www.thecarolinascenter.org
www.thecarolinascenter.org
Program, a quality improvement
initiative sponsored by the Centers
for Medicare & Medicaid Services
(CMS). CCME provides educational conferences and workshops, inservice training for certified nursing
assistants, and tools and resources
to assist providers in reducing the
rate of pressure ulcers. CCME’s
ultimate goal is to help providers
develop uniform and effective strategies to streamline coordination of care, promote skin care
protocols, and provide staff education.
CCME has been conducting skin care seminars for its
participating providers and providing them with a training
module developed and shared by the Louisiana Health
Care Review, Inc. The module is an in-service resource
designed as a Train-the-Trainer Program for nursing staff.
The comprehensive, hands-on educational activities are
designed to develop the skills and knowledge of certified
nursing assistants (CNAs) in the prevention of pressure
ulcers.
“Abbeville Nursing Home and Abbeville Area Medical
Center took this one step further,” Seaberg said. “With the
support of senior leadership and their dedicated nursing
professionals, they closely worked together to expand the
program and made it an all day Skin Care Fair. They provided education to the professional nursing staff, as well as
the CNAs, by creating additional training aids, posters on
staging, and various products used to treat pressure ulcers.
They further enriched their staff by their joint commitment
to prevent pressure ulcers.”
(Cont’d, See Cross-Setting Collaborations, page 4)
CCME Success Stories
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