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JFK Johnson Magazine

JFK Magazine Winter 2019



video pregnancy

Congratulations to JFK Family Medicine Center: Center for Pregnancy for being selected as a 2015 Community Leader of Distinction!

Hospital Acquired Pressure Ulcers

Pressure ulcers are areas of damaged skin and underlying tissue caused by staying in one position for too long. They commonly form where bones are close to the skin, such as the back, heels and hips. A patient who is bedridden, uses a wheelchair, or is unable to change position is at risk.

Pressure ulcers are slow to heal, so prevention is our focus. A comprehensive program for prevention of pressure ulcers was begun in 2011. The program uses evidence based best practices. Nursing leadership combines with patient care unit champions and focuses on how to identify patients at risk for pressure ulcers, implementing evidence based prevention protocols, evaluating new equipment and products as they become available, promoting interdepartmental collaboration, providing extensive education and numerous other measures all aimed at preventing pressure ulcers.

What are we measuring?

The number of pressure ulcers that occurred while the patient was in the JFK Hospital or Johnson Rehabilitation Institute (JRI).

2016Q4 PU 1


What is our performance telling us?

The graph above shows the sustained success of our program and a substantial decrease in the number of hospital acquired pressure ulcers since 2011. This is an ongoing program and we are committed to keeping our focus on protecting our patients from pressure ulcers.

What can you do to prevent pressure ulcers?

While you are in the hospital and in bed you should turn from one side to the other at least every two hours. Your heels should be elevated so they are not resting on the bed. When you are in a chair you should shift your weight at least every two hours. You may also sit on a pillow.

The nursing staff will check your skin to look for signs of pressure on the skin.

Whether you are at home or in the hospital, you are at risk for developing a pressure ulcer if you:

  • Spend most of your day in a bed, a chair, or a wheelchair
  • Are overweight or underweight
  • Are not able to control your bowels or bladder
  • Have decrease feeling in an area of your body
  • Spend a lot of time in one position

Here are some of the things you can do to prevent pressure ulcers:

  • Do NOT put pillows under your knees. It puts pressure on your heels
  • NEVER drag yourself to change your position or get in or out of bed. Dragging will cause skin breakdown. Get help if you need moving in bed or getting in or out of bed.
  • If someone else moves you, they should lift you or use a draw sheet (a special sheet used for this purpose) to move you.
  • Change your position every 1 - 2 hours to keep the pressure off any one spot.
  • Sheets and clothing should be dry and smooth, with no wrinkles.
  • Remove any objects such as pins, pencils or pens, or coins from your bed.
  • Do not raise the head of your bed to more than a 30-degree angle. Being flatter keeps your body from sliding down. Sliding may harm your skin.

Below is a link to the National Library of Medicine health information website. Click the link below for additional information.

Catheter Associated Urinary Tract Infections (CAUTI)

A urinary tract infection is an infection that can occur in the kidneys, in the tubes that take urine from the kidneys to the bladder, or in the bladder. An indwelling urinary catheter is a tube placed inside the bladder that drains urine to a bag outside the body. Some patients need urinary catheters to help monitor and treat certain conditions; for example, patients who are critically ill and require close monitoring, patients who are recovering from surgery and patients who cannot pass urine. Patients who have indwelling urinary catheters are more likely to get a urinary tract infection.

JFK uses evidence based best practices to reduce the chance of CAUTI. Interventions to reduce CAUTI include maintaining aseptic technique when inserting a catheter, using a separate emptying container for each patient, and using a device to secure the catheter tubing to a patient’s leg. In addition, each day the critical care nursing staff reviews the need for the catheter on every patient and discusses removal or alternatives with the physician when the catheter is no longer needed.

What are we measuring?

The rate of patients with catheter associated urinary tract infections in the critical care units (ICU and CCU).

Note: Hospitals and other websites use different ways to calculate rates. We calculate rate using 1000 catheter days as the denominator and the number of CAUTIs as the numerator.

2016Q4 Cauti 1

What is our performance telling us?

The critical care graph shows the occurrence of CAUTI in the critical Care units over time on a slight downward trend. It is our goal to eliminate CAUTI. In September 2016, we experienced an increase in the rate. With daily focus on the need for these catheters and proper maintenance, the rate dropped the next month. 

CAUTI rates may be reported on public websites such as Hospital Compare; different periods for reporting data can show different rates of CAUTI. The graph above shows rates through December 2016. 

What are we measuring? 

In addition to critical care alone, we measure the combined monthly occurrence of CAUTI in critical care and medical surgical patient care units. 

2016Q4 Cauti 2

Note: Hospitals and other websites use different ways to calculate rates. We calculate rate using 1000 catheter days as the denominator and the number of CAUTIs as the numerator.

Beginning January 2016 the Hospital Compare website began reporting a CAUTI metric for medical and surgical as well as critical care patient units. The graph above displays that data. There is a slight upward trend. A multidisciplinary team reviews each occurrence to look for additional opportunities to eliminate CAUTI.

Hospital Compare uses a standardized infection ratio to report CAUTI.

The graph below shows that JFK has lower (better) SIR than the National SIR for critical care and medical surgical patient care units combined.

2016Q4 Cauti 3

What is our performance telling us? 

It is our goal to eliminate CAUTI. We use the most current best practice guidelines to improve our processes and continue to work to reduce and ultimately eliminate CAUTI. Every day the nurses and physicians review the need for continuing these catheters and discuss whether the catheter can be removed. In addition, a team reviews each CAUTI individually to determine the cause and identify ways to reduce CAUTI.

What can you do to prevent a CAUTI?

  • If you do not see your providers clean their hands, ask them to do so.
  • Always keep your urine bag below the level of your bladder.
  • Do not tug or pull on the tubing.
  • Do not twist or kink the catheter tubing.
  • Ask your healthcare provider each day if you still need the catheter.   

Ventilator Associated Pneumonia (VAP)

Ventilator associated pneumonia (VAP) is an infection that develops in a person who is on a ventilator, or breathing machine. Ventilators can be life saving but also make it easier for patients to get pneumonia. Nurses, physicians, respiratory therapists and other healthcare workers use evidence based best practices to prevent VAP such as keeping the head of the bed up 30 – 45 degrees, checking the patient's ability to breathe without the machine every day so that the ventilator can be removed as soon as possible, washing their hands before touching the patient or the ventilator, and cleaning the inside of the patient's mouth every day.

What are we measuring?

The graph shows the number of VAP cases on our designated ventilator patient units throughout the hospital.



What is our performance telling us?

The graph shows that since January of 2011 there have been only two cases of ventilator assisted pneumonia occurring anywhere throughout JFK. This is a low incidence of VAP. Our healthcare team follows best practices and is committed to continue to keep the focus on avoiding VAP.

Preventing Patient Falls in the Hospital

Falls are a common cause of injury, both within and outside the hospital setting. According to the U.S. Centers for Disease Control and Prevention, more than one-third of adults over 65 fall each year. While not all falls cause injury, falls can be serious and may result in bone fractures, excessive bleeding, or even death.

More than one-third of adults over age 65 fall each year. They account for about 2 million emergency department visits.

Patients have a higher risk of falls if they

  • Have an impaired memory.
  • Are older than 60.
  • Have weak muscles or problems walking.
  • Take drugs or a combination of drugs that make them sleepy.
  • Use a cane or walker.
  • Have chronic conditions.
  • Need to use the bathroom frequently.

At JFK we use best practice evidence based processes to prevent patient falls. Every hospital inpatient is assessed for their risk to fall. Special precautions are taken for patients considered to be at a high risk to fall such as:

  • Providing assistance when patients transfer in and out bed.
  • Keeping the call bell in reach.
  • Using a safety belt while in a wheelchair.
  • Placing a yellow wrist band on the patient to alert staff that a patient is at risk of falling.
  • A blue wrist band may also be used to as a reminder when a patient should not be left alone in the bathroom.
  • Using non skid yellow socks.
  • In some instances a bed alarm is used as an alert when the patient leaves the bedside without assistance.

Preventing falls is not simple. Fall precautions must be balanced with other patient care considerations such as minimizing restraints and promoting mobility.

Keeping patients safe by preventing falls is one of our highest priorities.

What are we measuring?

We define a fall as any sudden, uncontrolled, unintentional or intentional dropping downward from a standing, sitting or lying position that results in landing on or contact with a surface or object. This includes instances where a staff member is present and intervened to prevent injury.

We track all patient falls including those without injury and where a staff member was present and assisted the patient to the floor to prevent injury.

The graph shows a rate of inpatient falls. The rate is determined by dividing the number of falls by the number of patient days and multiplying by 1000. This rate is an industry standard.



What is our performance telling us?

This graph shows that our efforts to prevent patient falls are working. The downward trend line shows that fewer patients are falling. However, we continue to work to reduce falls by staying current with best practices and reviewing all falls. This allows us to find opportunities to enhance our fall prevention program.

Keeping patients safe by preventing falls is one of our highest priorities. Our goal is to eliminate injuries from falls.

What can you do to reduce the chance of patient fall?

Patients, families and visitors have an important role in preventing falls. You can help avoid falls by:

  • Making sure that needed personal items as well the the call bell are within reach.
  • Not leaning on furniture or using the IV pole for support.
  • Always using the call light before getting out of bed for any reason.
  • Wearing the non skid yellow socks.
  • Sitting at the bedside and standing slowly when getting out of bed.
  • Not interfering with bed alarms.

Patients as well as their families and visitors are essential members of the health care team and can help avoid falls. Printed information on the prevention of falls is given to each new patient. Patients and their families should read this important information. In addition, there are poster board presentations on patient care units that provide information about fall risk assessments, requesting assistance, and strategies to prevent falls.

Additional information about how you can prevent hospital patient falls and falls outside the hospital at this Agency for HealthCare Quality and Research webpage: