WRNMMC, Bethesda, Md.  –   Decreasing hospital-acquired (preventable) pressure injuries is a top priority of military medical treatment facilities (MTFs), and a Walter Reed team recently received the 2023 Military Health System (MHS) Ready Reliable Care (RRC)/High Reliability Organization (HRO) Award for its efforts focused on this challenge.

“Our multidisciplinary team examined our current pressure injury prevention program and developed measurable goals with intervention to meet those goals in order to reduce hospital-acquired pressure injuries,” stated Dawn Ford, a certified wound ostomy continence foot care nurse and certified lymphedema therapist at Walter Reed who served as the project lead.

She explained that hospital-acquired (preventable) pressure injuries are “skin and/or tissue injuries from unrelieved pressure to an area of the body that could have been avoided if risk for pressure injury was correctly assessed and appropriate preventative interventions were readily put in place.”

The work of the Walter Reed team in preventing these injuries earned them the 2023 Advancement Toward RRC/HRO MHS Culture of Safety Award, which they received Feb. 15 at the National Harbor in Maryland during the MHS Excellence Awards Ceremony.

Awards presented during the ceremony recognized achievements in leadership, innovation, high reliability, management, and other elements of military medicine. The awards are part of the effort by the Department of Defense to transform the MHS into a RRC/HRO, ensuring safe, reliable care for MHS beneficiaries.

In addition to Ford, the Walter Reed team earning the award included Agnes Reis (RN, Wound Care), Ashley Thomas (RN, Wound Care), Cmdr. Maricar Aberin (Quality Liaison for the Directorate for Nursing Services), Lt. Cmdr. Latarya Gulley (Clinical Education Department chief), Lt. Cmdr. James Jeff (clinical nurse specialist), Lt. Cmdr. Sarah Hull (clinical nurse specialist), Aubrey Lewis (respiratory therapist), Ruth Badja Tchaptchet (RN), Dr. Lauretta Walker (inpatient Physical Therapy), Lt.j.g. Elohor Okoko (RN), Maj. Sarah Hensley (Quality Liaison), HeeSoo Oh (Patient Safety), Kimberly Wu (Patient Safety), Dr. Dana Koester (project coach) and Dr. Brandon Neal (project coach).

“We worked to improve availability of pressure relieving adjuncts and emphasized the importance of documentation with the incorporation of an audit program,” Ford stated. She explained that this was done with a focus on pressure injury prevention education, improved communication between the wound team, nursing, patient safety and nursing leadership.

Ford added the two-and-a-half-year project was not only driven by the need to improve the culture of safety through reduction of health care-acquired (preventable) pressures injuries and associated harm at MTFs, but also to promote “sustainable teamwork between the wound care management team and direct-care inpatient staff by addressing performance gaps leading to confusion on roles/responsibilities regarding the ownership, detection and intervention of pressure injuries.”

“Our A3 team, much like pressure injury prevention, is multidisciplinary with valuable contributions from many disciplines leading to the Walter Reed/Bethesda’s achievements in preventing hospital-acquired pressure injuries,” Ford added.

“The MTF realized a 52.8 percent reduction in overall pressure injury incidents from CY (calendar year) 2021-22, meeting the 20 percent or greater reduction target by the end of CY2022. In addition, the MTF also realized zero sentinel/serious reportable events in CY2023 as of Aug. 16, 2023,” according to the project’s abstract.

The team used an eight-step practical problem-solving methodology to tackle the hospital-acquired (preventable) pressure injuries challenge, the abstract explained. The methodology included clarifying the problem; breaking down the problem and identifying performance gaps; setting improvement target; determining root causes; developing countermeasures; implementing countermeasures; monitoring process and confirming results; and sustain and sharing success.

“Efforts to reduce hospital-acquired pressure injuries fully incorporated the seven guiding [RRC] principles:

• Preoccupation with failure – Implementing countermeasures specifically aimed to drive zero harm by anticipating patients at risk for pressure injuries and addressing risks through 100 percent consults for every incident.

• Sensitivity to operations – The skin wound assessment team (SWAT) supports the direct-care inpatient staff during the wound management process at the bedside. Improvements to training and availability of training opportunities promote standardization of wound care management across all inpatient units.

• Deference to expertise – Implementation of the pressure injury prevention policy enabled 100 percent collaboration between direct-care inpatient staff and the SWAT.

• Respect for people – Continuous collaboration between the SWAT and direct-care inpatient staff ensuring wound care management practices remained feasible and effective.

• Commitment to resilience – Sustainment of implemented countermeasures remains a key component of the MTF’s top patient safety priorities. Ensuring all direct-care inpatient staff receive standardized wound care management remains a challenge, however, leadership is committed to sustaining and using multiple methods for training delivery.

• Constancy of purpose – …The project’s primary strength involved consistent staff collaboration…ultimately influencing an overall reduction in pressure injuries for CY2022. In addition, zero sentinel/serious reportable events occurred in CY2023 as of Aug. 16, 2023.

• Reluctance to simplify – Although pressure injuries occur throughout inpatient health care facilities worldwide, the MTF sought to identify locally-occurring performance gaps and address preventable pressure injuries in support of becoming a high reliability organization.

“Implemented efforts to reduce hospital-acquired (preventable) pressure injuries serve as a potentially replicable example of the MTF’s commitment to safety and harm prevention and advancement of high reliability in the MHS,” the abstract concluded.

According to MHS officials, the RRC/HRO Awards Program “recognizes initiatives improving the MHS and seeking approaches and enhancements in both clinical and non-clinical areas that improve health, build readiness and resilience, and demonstrate excellence. “The goal of the awards program is to promote a continuous learning culture that drives improvement in performance, innovation, staff and patient satisfaction, and retention. This program provides an opportunity to identify and recognize projects that deserve broader awareness and possible implementation across the enterprise,” stated MHS officials, who evaluated award submissions based on use of the seven RRC principles.