Southern HealthCare Reduces PIs and Creates a Culture of Prevention

“Across the profession, we have developed strong systems for responding to skin impairments; however, there is an opportunity to further strengthen our approach by focusing more intentionally on prevention,” says Dawn Chery, Chief Nursing Officer of Southern HealthCare Management.

“With CAPI [community-acquired pressure injuries] in particular, the profession would benefit from drilling deeper into the underlying clinical, operational and system-level factors that contribute to skin impairments,” Chery notes. “By using data-driven analysis, interdisciplinary collaboration and proactive care planning, organizations can shift from a primarily reactive posture to one that meaningfully reduces risk and improves resident outcomes.”

Pressure injury prevention remains a top priority for post-acute facilities, but skin breakdown remains frustratingly common, especially in settings where residents and rehab patients may be immobile for long periods of time. Southern HealthCare Management wanted to improve the situation for its 43 centers.

CHALLENGE

Rising PI rates and unnecessary costs

Following the pandemic, Southern HealthCare centers experienced an increase in resident acuity. In response, Southern HealthCare recognized the need to shift caregiver focus from primarily reacting to skin breakdown to proactively preventing pressure injuries through early intervention and consistent preventive practices.

“We reviewed the clinical acuity of the residents that we serve at our centers, and we identified that we needed a more proactive, evidence-based approach in skin management, not just pressure injuries, but any other skin-related situations that may occur while residents are in our centers,” Chery explains. “Our deeper review revealed that strengthening preventive practices was our greatest need.”

One barrier to achieving pressure injury prevention goals was the use of a broad, non-standardized formulary of skin care products and support surfaces without consistent clinical guidance. “Much of the challenge stemmed from limited awareness of available products and their appropriate application,” Chery explains.

This lack of standardization resulted in variability in routine skincare practices and inconsistent selection of mattresses and wheelchair cushions across centers. In addition to clinical risk, these inconsistencies drove increased operational costs, including avoidable mattress rentals. “They wanted to get to a point where frontline staff could follow guidelines and select tools that fit the resident’s risk profile,” notes Anita Meador, BSN, RN, BC, CWCN, COS-C, Medline Senior Clinical Resources Manager.

“Much of the challenge stemmed from limited awareness of available products and their appropriate application.”

—Dawn Chery, Chief Nursing Officer of Southern HealthCare Management

ACTION

Partnering with Medline for formulary changes

To achieve their prevention goals, Chery reached out to her reps at Medline to address several key areas for their product formulary: skin care, support surfaces, heel offloading and prophylactic dressings. Here’s what they did:

1. Standardize skin care and product education

Rebuilding their skin care formulary was the first step in the process. “We trialed Remedy® cleansers, moisturizers and barriers in a few of our centers and we found that the results were pretty impressive,” Chery says. Southern HealthCare has since converted all the centers from standard products to Remedy. Product education was embedded in the rollout and is now offered during nurse orientations and annual refreshers, with educators including hands-on training whenever possible.

“The most poignant example we had was when we hosted meetings with our certified nursing assistants, and we placed the barrier cream on our hands,” Chery describes. “We then put water on the barrier, and they were able to see the water bead on our skin instead of just slide off. We heard a lot of, ‘Oh wow, look at that, I see the benefits.’”

As with any significant practice change, there were instances early on when Chery and her team visited centers and found legacy skin care products still in use rather than the standardized Remedy line. “It required ongoing dialogue and clear communication around the rationale for the conversion,” she explains. “Over time, we saw increased compliance and stronger staff engagement, to the point where the new practices are now second nature.”

2. Build a support surfaces algorithm

Next step was an evaluation of support surfaces. “Centers ordered support surfaces without an evidence-based process to determine which options were most appropriate for each resident.”

The mattress evaluation, led by Medline, helped Southern HealthCare to settle on three support surfaces that would work for residents of all risk levels.

• EqualizeAire™ hybrid is a self adjusting air-plus-foam mattress for residents at moderate risk of pressure injury.
• MedTech Air MAX is a true low air loss system for higher risk residents.
• Standard foam choices are available when a resident is at low risk.

It was also important to Chery to provide clear direction for nursing staff to select the right surface for the right resident. “We developed a support surfaces algorithm based on the resident’s Braden Scale and their mobility status,” Chery says. “The algorithm empowers admitting nurses and DONs to select appropriate support surfaces.” They also incorporated into the formulary wheelchair cushions, heel boots and wedges for proper offloading of common pressure injury points.

3. Add a transparent prophylactic dressing

To complement skin care and support surface updates, Southern HealthCare centers also adopted OptiView® transparent dressings to help prevent skin breakdown prophylactically. “Every center I visit, I hear that nurses love the fact that they can see right through it, that it doesn’t have to be removed and then placed back on or require them to find another dressing,” Chery says.

Ongoing education summits

Southern HealthCare education leaders coordinated with Meador to provide product training. Meador explains, “We conduct wound care nurse summits as it relates to the Medline skin health formulary and process, and we assist the Southern HealthCare team members with education for regional clinical directors as well as directors of nursing.”

Chery says, “Anita has been a big part of the success of this program and this project.”

“They wanted to get to a point where frontline staff could follow guidelines and select tools that fit the resident’s risk profile.”

—Anita Meador, BSN, RN, BC, CWCN, COS-C, Medline Senior Clinical Resources Manager

OUTCOME

Trends point to fewer PIs

Staff now “starts with prevention” instead of reacting, Chery says. “As far as data trends, they do show that the incidence of pressure injuries has decreased, and our healing times have improved as well,” Chery reports.

“Medline was really instrumental in showing us where we could review our current formulary versus what the more evidence-based products are that are available to our profession,” Chery explains. She says that the use of OptiView has helped staff more quickly identify early-stage pressure injuries, which has, in turn, improved the opportunities to reduce residents at risk developing further skin injuries.

Other positive outcomes they’ve seen include:

Staff confidence increased. Staff confidence increased as the standardized skin care formulary and support surface selection algorithm removed uncertainty from risk assessment and care planning. With clearer guidance, staff was better equipped to deliver appropriate, preventive care. “That’s a huge win for us,” Chery notes.

She now observes the new skin care formulary and support surfaces algorithm take the guesswork out of risk assessments, allowing staff to provide the necessary care for residents. She also sees CNAs actively mentoring new team members on the program, speaking with confidence and reinforcing education—often demonstrating the Remedy barrier training they themselves received.

Resident comfort improved. Previously, some residents reported discomfort with mattresses and difficulty sleeping. “Now our residents are satisfied with the support surfaces,” Chery says. “It’s been a resounding success, and we’ve received no ongoing concerns regarding mattress comfort.”

Costs were reduced. Stocking standardized surfaces eliminated rental expenses and shortened response time to resident needs. “From an operations standpoint, what we found with the support surfaces formulary is that it’s also allowed us to be more fiscally responsible by reducing unnecessary rentals,” Chery says.

“We’ve decreased rental costs and helped ensure that high risk residents have the advanced support surfaces that they need without having to wait on that rental mattress or rental cushion to arrive at the centers,” she explains.

Culture of prevention developed. Small wins were celebrated, and leaders made the education continuous, not one and done. “If we recognize the small wins, it’ll lead to even bigger wins,” Chery says. “When our direct care staff sees the positive impact of their work and the program that we put in place, engagement really does grow. That’s what warms my heart,” Chery says.

“It showcases that we’re providing individualized person-centered care to our residents. We’re identifying risk, highlighting the care needs of the residents from admission and ensuring that the care continues.”

Chery says that her advice for other centers looking “to be just as successful as we’ve been” would be to “build a program that’s consistent, evidence-based, proactive and easy for the staff to follow.”