4 Eyes in 4 Hours Skin Care Team

4 Eyes in 4 Hours • Skin Care Team Mindful Rounding – #20 by your Skin Care Team: • Penny Pitford CWON and Aleatha Myers WON

4 Eyes in 4 Hours Program to assure that all pressure injuries that are present upon admission are found and charted timely. It requires the primary nurse and a second nurse (or tech) to complete a skin assessment and chart it with in 4 hours of admission.

4 Eyes in 4 Hours • Upon admission every patient will get a full head to toe skin assessment by the primary nurse and charted within 4 hours. • They will also get a second set of eyes (another RN or tech) to do a full head to toe skin assessment. This will also be charted within the first 4 hours by means of a co-signature. These two assessments can be simultaneous or separate. • Take pictures of all pressure injuries POA. • The charting will be monitored by automated audits.

4 Eyes in 4 Hours • The primary nurse charts their assessment in the patient’s chart. Including all wounds and wound assessments (staging and measurements). • The second staff member reviews the primary nurses’ charting. • If they agree on the entire wound assessment then the second nurse will co-sign the primary nurses wound assessment (example on next slide). • If they do not agree on the wounds that are present. A conversation needs to happen, charting needs to be corrected, then once the second nurse agrees with the primary nurses’ charting then the co-sign can occur.

4 Eyes in 4 Hours: Co-Signing

4 Eyes in 4 Hours: Co-Signing

4 Eyes in 4 Hours: Co-Signing

4 Eyes in 4 Hours For an undetermined amount of time, our management has committed to rewarding staff for pressure injuries found present on admission. The primary nurse and second nurse (or tech) which finds any pressure injury present on admission are both eligible. ***Eligibility for reward requires a picture in the chart. *** *It must be saved under the content type “WOUND CARE”. * Stay tuned for more information on the rewards.

4 Eyes in 4 Hours • Why are we doing this 4 eyes in 4 hours program? • If a pressure injury, which is present upon admission, isn’t charted w/in the first 24 hours our hospital suffers very large financial hits. Numerous other hospitals have moved to this practice. Nurses state that they don’t notice a significant increase in time required to complete the task and the hospitals state that they have dropped their Hospital Acquired Pressure Injury (HAPI) significantly (as much as 50%). • It is a small step to insure a large financial improvement. • We have to count it as a HAPI if it isn’t charted on admission. • This program applies to all stages of pressure injuries. • Our documentation speaks to our level of attention to detail.