Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guidelines )

European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance

(Updated 05/21/24) In 2019, a full set of Clinical Practice Guidelines were developed, by the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guidelines, The International Guideline and can be purchased for a fee. In addition, a Quick Reference Guide (QRG), which provides a summary of the recommended guidelines can be downloaded for no charge.

Managing the Risks of Direct Oral Anticoagulants

The Joint Commission: Sentinel Event Alert

While DOACs offer ease of use to patients, stopping bleeding events in patients on DOACs is more complicated, requiring different strategies than those for patients on warfarin (Coumadin®) and heparin. Unlike the more widely available reversal agents for warfarin and heparin, reversal agents for DOACs are lesser known and may not be available in every care setting. Also, some DOACs have no FDA-approved reversal agent at this time. Therefore, bleeding complications can be severe if these patients are not assessed according to guidelines on the management of DOACs. Intracranial hemorrhage is the most serious emergent bleeding risk.

In response to an increase in adverse events related to these widely prescribed medications, this alert provides guidance on the safe use and management of DOACs to all medical practitioners and health care organization leaders, particularly chief medical officers, pharmacists, emergency department clinicians, and quality and safety officers.

Anticoagulation FORUM: Numerous Resources and Expert Guidance

Anticoagulation FORUM

  • Education & Guidance
  • Webinars and Events
  • Centers of Excellence
  • Anticoagulation Stewardship

Established more than 25 years ago, the Anticoagulation Forum is the largest organization of its kind helping practitioners improve patient care by providing current and relevant information on best practices. The flagship program, the Anticoagulation Centers of Excellence, embodies our commitment to the clinical application of evidence-based practices and improved patient outcomes. Expert Guidance is provided by the Board of Directors, who are regularly relied upon for their expert opinion. Their contributions to research and guideline development have influenced all aspects of anticoagulation therapy.

Preventing Hospital-Associated Venous Thromboembolism: A Guide for Effective Quality Improvement

Agency for Healthcare Research and Quality (AHRQ)

Pulmonary embolism resulting from deep vein thrombosis—collectively referred to as venous thromboembolism—is the most common preventable cause of hospital death. Pharmacologic methods to prevent venous thromboembolism are safe, effective, cost-effective, and advocated by authoritative guidelines, yet large prospective studies continue to demonstrate that these preventive methods are significantly underused. Based on quality improvement initiatives undertaken at the University of California, San Diego Medical Center and Emory University Hospitals, this guide assists quality improvement practitioners in leading an effort to improve prevention of one of the most important problems facing hospitalized patients, hospital-acquired venous thromboembolism.

Eliminating Disparities to Advance Health Equity and Improve Quality

MHA Keystone Center

The MHA Keystone Center encourages organizations to use this guide to assess the current level of hospital implementation around key strategies aimed at reducing disparities to achieve equity and improving quality. This resource will guide organizations to prioritize and act on identified gaps so that deliberate and purposeful action is taken to ensure that the outcomes across all patient populations are equitable. Sections of the guide include:

Section 1: Understanding Key Terms

Section 2: Why Equity in Care Matters

Section 3: Strategic Pillars on the Journey Toward Equity

Section 4: Recommendations for Action

Section 5: Levels of Implementation

Section 6: The MHA Keystone Center’s Dedication to

Achieving Health Equity

Section 7: Resource Compendium

Modernizing Health Care to Improve Physical Accessibility

Centers for Medicare and Medicaid Services (CMS)

The resources in this inventory include guidance on how to increase physical accessibility of medical services, tools to assess your practice or facility’s accessibility for individuals’ disabilities, and tips and training materials to support efforts to reduce barriers and improve quality of care. This document is intended to provide recommendations on how to improve accessibility in order to improve quality of care for patients with disabilities.

The Role of Nutrition for Pressure Injury Prevention and Healing (White Paper): The 2019 International Clinical Practice Guideline Recommendations

European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP), and Pan Pacific Pressure Injury Alliance (PPPIA) Prevention and Treatment of Pressure Ulcers/Injuries.

Nutrition plays an important role in the prevention and treatment of pressure injuries (PIs). Macro- and micronutrients are required by each organ system in specific amounts to promote growth, development, maintenance, and repair of body tissues. The 2019 European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP), and Pan Pacific Pressure Injury Alliance (PPPIA) Prevention and Treatment of Pressure Ulcers/Injuries:
Clinical Practice Guideline (EPUAP/NPIAP/PPPIA CPG) provides guidance on the prevention and management of PIs. This guideline was a collaboration between the EPUAP, NPIAP, and PPPIA with the assistance of 14 associate organizations. The goal of this international collaboration was to provide an updated, comprehensive review of the research literature and develop recommendations
reflecting recent evidence. The intent is for health professionals around the world to use the recommendations generated to prevent and treat PI.

Direct Oral Anticoagulant: DOAC Playbook

Anticoagulation Forum

Although DOACs require less intensive dose management than warfarin, they are not devoid of potential complications. Anticoagulants have consistently ranked as the class of medications most frequently leading to emergency room visits and hospital admissions for adverse drug events. This toolkit explains how to use DOACs safely and effectively requires that all aspects of anticoagulation therapy are addressed, including appropriate patient selection, dosing, monitoring, transitions between therapies and between care settings, periprocedural guidance, management of risks (including DOAC associated
bleeding), drug-drug interaction management, ongoing assessment of patient and family educational needs, and incorporation of evidence-based practices into workflow.

Hospital Roadmap for Person and Family Engagement (PFE): Achieving the Five PFE Best Practices to Improve Patient Safety and Health Equity

American Institutes for Research (AIR) for IPRO HQIC

This PFE Roadmap provides practical guidance to help hospitals implement five PFE best practices:

  1. Implementation of a planning checklist for patients who have a planned admission
  2. Implementation of a discharge planning checklist
  3. Conducting shift change huddles and bedside reporting with patients and families
  4. Designation of a PFE leader in the hospital
  5. Active Person and Family Engagement Committee or other committees where patients are represented and report to the board

How Patient and Family Advisory Councils Can Help Hospitals and Their Communities During the COVID-19 Pandemic

American Institutes for Research (AIR) for IPRO HQIC

COVID-19 is a perfect issue for PFACs to address. The experiences of patients and families can have a direct impact on how the hospital safely treats those with severe cases including those in isolation, prevents the spread of the virus, and minimizes the impact of the virus on health care and health outcomes (e.g., delayed care). This resource provides suggestions about how PFACs can help hospitals proactively communicate, educate, and engage with patients and families and the larger community to build trust and deliver high-quality care during a time of uncertainty and fear.

Reliability Culture Implementation Guide

Michigan Health & Hospital Association, Illinois Health and Hospital Association, Wisconsin Hospital Association, Minnesota Hospital Association

Purpose: The Reliability Culture Implementation Guide combines the five principles of high reliability organizations (HROs) with elements of safety culture. This guide is broadly intended for executive level to frontline staff. Tools are available throughout this guide to support and advance the work done within high reliability.