"In the development of the HAPU Prevention Program, the caring science was used as the theoretical framework. Three Caritas Processes were selected to build a strong infrastructure: Teaching and Learning; Holistic Care; Creating a Healing Environment. "

1. Kaiser Permanente, Northern California
Caritas Consortium 2013
Caring Science as a Lens to Reframe & Revitalize HAPU Prevention
Caritas in Action
How Caring Science informs and inspires KP caregivers and affirms our commitment to provide our
patients and their families exceptional care

2. Caring Science as a Lens to Reframe & Revitalize
HAPU Prevention
Intent to Contribute Statement:
KP Santa Clara was identified as having the highest hospital acquired pressure ulcer rate in the entire
company in 2012.
The Data: Metrics prior to development of caring infrastructure: CalNoc, HAPU Data by volume, and
1K/patient days. In the development of the HAPU Prevention Program, the caring science was used as
the theoretical framework. Three Caritas Processes were selected to build a strong infrastructure:

First caritas: Teaching and Learning focused on several areas: Failure Modes Effect Analysis, Onsite Visit to
KP Sacramento's best practices; understanding the etiology of pressure versus non pressure; bringing a
variety of educational offerings to the multidisciplinary team including frontline staff.

Second caritas process: Holistic Care with early identification of pressure ulcers on admission; total head to
toe assessment including the skin; performing root cause investigations on all HAPUs to uncover both
psychosocial and physiological activities.

The third caritas process is creating a Healing Environment which focuses on the environment to promote
sustainability with gains with this HAPU Prevention Program, such as moving from a reactionary to a
proactive mode of care delivery and auditing 2 RN Verification for all patients on admission and transfer
and those patients with a Braden Score of 16 or less during shift.
This Caring Approach has improved the quality of patient care in the area of HAPU Prevention by
having improved CalNoc Prevalence and Incidence Study in Quarter 3 and 4 of 2012 and Quarter 1 in
2013 with dramatic reduction of HAPUs in Quarter 4 2012 and Quarter 1 2013.
Page 2

3. Caring Science as a Lens to Reframe & Revitalize
HAPU Prevention
Inspired Contributor(s) 1 :
 Kathy Ricossa
-----Service Area: Santa Clara
Medical Center: SCL
Affiliation: PCS
-----Year Shared: 2013
Venue: Caritas Consortium
Format: Art, PowerPoint
ID #: 15
Page 3
Keyword TAGs:
Identifier
 Consortium2013-July, Santa
Clara, Podium, Poster, Patient
Care Services
 Education & Staff Dev, Hospital
Initiatives, Healing Environments,
Patients/Families
Descriptor
 HEROES, Research and Metrics

4. Caring Science as a Lens to Reframe & Revitalize
HAPU Prevention
Story: Respecting Patient/ Family Choice Through
Authentic Presence
Page 4

5. Welcome to Kaiser Permanente in Santa Clara!
Our Story…
Page 5

6. Cal Noc Prevalence and Incidence Studies
Page 6

7. HAPU Rates by Year
200
180
160
140
120
100
80
60
40
20
0
2009
Page 7
2010
2011
2012

8. 2012 HAPU Monthly Volume Report
Page 8
8

9. HAPU Prevention Examining the Caritas Processes
• Building a Strong Infrastructure
 Teaching and Learning
 Holistic Care
 Healing Environment
Reference

Page 9
DiNapoli, P., Turkel, M., Nelson, J., & Watson, J. (2010).
Measuring the Caritas Processes: Caring Factor Survey.
International Journal for Human Caring, 14(3), 15-20.

10. Teaching and Learning
• 2011-2013 Failures Mode Effects Analysis
• Learning from others

Learning from KP Sacramento Best Practices
• Bringing these best practices back to our facility
• Understanding the difference between pressure and non
pressure
• Bringing Wound Care educational offerings to the facility

Page 10
Distinguished Speakers; Vendor Days; Webinars

11. Holistic Care
• Identification of pressure ulcers on admission
• Examining the entire patient from “hair to toe”
assessment
• Involving all health care workers in a multidisciplinary
approach
• Performing Root Cause Investigations for all pressure
related skin alterations

Page 11
Uncover all aspects of the patient

12. Healing Environment
• Moving from reactionary mode to
proactive approach to identify patients
who are high risk
• Focus on the environment which
promotes keen assessments and
prompt interventions

2 RN Verification
—

Page 12
Admission, Transfer, During Shift
Turning Every 2 Hours

13. Is the Caring Science Model affecting our
patient care outcomes?
Page 13

14. HAPU Rates by Year
200
180
160
184
140
145
120
132
100
97
80
60
40
20
12
0
2009
Page 14
2010
2011
2012
2013

15. Cal Noc P&I Study Update
Page 15

16. Most Recent HAPU Data by Volume
Page 16

17. 2 RN Verification Admission
Page 17

18. 2 RN Verification on Transfer
Page 18

19. 2 RN Verification During Shift with Braden
Score 16<
Page 19

20. Page 20

21. Page 21

22. Page 22

23. Page 23

24. Page 24

25. Page 25

26. Page 26

27. Page 27

28. Page 28

29. Page 29

30. Page 30

31. Page 31

32. Page 32

33. Page 33

34. Page 34

35. Page 35

36. Page 36

37. Page 37

38. Page 38

39. Page 39

40. Page 40

41. Page 41

42. Page 42

43. Page 43

44. Page 44

45. Page 45

46. Page 46

47. Page 47

48. Page 48

49. Page 49

50. Page 50

51. Page 51

52. Page 52

53. Page 53

54. Page 54

55. Page 55

56. Page 56

57. Kaiser Santa Clara Cares
About HAPU Prevention
Page 57

58. The Magic of KP Santa Clara Continues…
Page 58

59. Thank you for allowing me to share our
story
• Contact Information
• Kathy.Ricossa@kp.org
Page 59
408.851.7804