Chris Hendry Director NZ Institute of Community Health Care (Friday, 10.05am, Sigma Room)

1. Chris Hendry
Director
NZICHC
www.nzichc.org.nz Details in here

2. 1. The context of Nurse Maude.
2. The Specialist Wound Care Service
3. Development of the HER
4. Audit of data
5. Audit findings
6. Issues identified
7. Recommendations

3. Nurse Maude is one of the largest providers of District Nursing Services in
New Zealand with a staff of over 800 nurses and health care workers.
Located in Christchurch, in the past 12 months provided:
• 16,654 referrals
• 180,414 district nursing visits
• 472,273 home care visits
• 3,929 hospice bed days
• 86,826 specialist nursing visits
• including 46,652 for wound care.

4. The nurses provide a community
based Specialist Wound Care Service
for patients who have:
•wounds that are failing to heal
•complex wounds
•a risk of wound development.
They work from 2 clinic sites, one in
the city and one rural and provide
consultancy for CDHB region wide.
In 2009 they commenced routinely
using the EHR function within
SilhouetteMobile®, an electronic
wound measurement tool.

5. Nurses had been informing development of an EHR integrated within
the SilhouetteMobile® system which also provides 3D wound
measurements.

6. Documentation requirements for nurses:
• Demographic and administrative information (PMS)
• Patient assessment information (hard copy files)
• Wound measurements (SilhouetteMobile® electronic
measurements)
• Planning and treatment information (hard copy files)
Vision for integration of this information within an Electronic Heath
Record (EHR).
The EHR had been in development and increasing use within wound
clinic from 2009 onwards.
The records were stored centrally and data was able to be extracted
for analysis.

9. The following data was used for analysis:
1. Referrer to the service
2. Number of patients
3. Number of visits
4. Age
5. Gender
6. Ethnicity
7. Height
8. Weight
9. Smoking status
10. Co-morbidities
11. Contributing factors to wound complexity
12. Mobility
13. Medications
14. Previous wounds
15. Wound site
16. APBI score (PVD)
17. Use of compression hose
18. Wound sizes

10. Table 1. Frequency of patients assessed at the specialty wound clinic
Client visits Number of patients Percent of patients
1 382 35.9
2-4 315 29.6
5-7 132 12.4
8-10 76 7.1
11-13 39 3.7
14-16 29 2.7
17-19 17 1.6
20+ 75 7.0
Total 1,065 100.0
Of the 1,065 patients, 562 (52.8%) had these assessments recorded on the SilhouetteMobile tool.
Reasons for those not being included in the tool related to:
• wounds could not be captured by the tool;
• patients who had no wounds, but were receiving wound prevention advice and treatment;
• an incomplete data set on the patient;
• unavailability of the tool and computers;
• problems with the device ‘ crashing’ .

11. Table 2. Frequency of patients assessed at the specialty wound clinic
Referrer Patients Percent
General Practitioner 258 45.9%
District Nurse 171 30.4%
Vascular surgeon 34 6.0%
Other 34 6.0%
Infectious disease team 5 0.9%
Plastic surgeon 2 0.4%
Lymphoedema specialist 2 0.4%
Hyperbaric team 2 0.4%
Dermatologist 2 0.4%
Podiatrist 1 0.2%
Not recorded 51 9.1%
Total 562 100.0%

12. Age and gender
BMI
BMI (kg/m2) Number of Patients Percent
Underweight (<18.5) 5 1.6%
Normal weight (18.5-24.99) 71 22.7%
Overweight (25-29.99) 81 25.9%
Obese (=>30) 156 49.8%
Total (known BMI) 313 100.0%
BMI Unknown 249
Grand total 562

13. Patients who smoke
Age Smoking status
No Percent No Yes Percent Yes
<45 28 5.7% 11 16.4% Multimorbidities
45-64 83 16.8% 30 44.8%
65-84 255 51.5% 24 35.8%
85+ 129 26.1% 2 3.0%
Total 495 100.0% 67 100.0%

14. Ambulation at first visit Patients Percent
Bed bound 2 0.4%
Mobility
Chair bound 21 3.7%
Independent with mobility aid or assistance 204 36.3%
Independent - no aid or assistance 288 51.2% Previous wounds
Not recorded 47 8.4%
Total 562 100.0% Episodes of
Patients Percent
previous wounds
0 73 13.0%
1 96 17.1%
Current wounds 2 76 13.5%
Wound Area cm 2
Number of wounds Percent of wounds 3 41 7.3%
<0.5 215 14.7% 4 18 3.2%
0.5 - <1 192 13.2% 5-10 47 8.4%
1 - <2.5 296 20.3%
11+ 6 1.1%
2.5 - <5 238 16.3%
5 - <10 183 12.5% Not recorded 205 36.5%
=>10 201 13.8% Total 562 100.0%
unknown 134 9.2%
Total 1,459 100.0%

15. 1.Benchmark of patients attending the service at a specific point in time.
2.Identification of key health issues (health promotion needs).
3.Impact of health promotion activities on patient’ s health and future health
service utilisation.

16. Organisational factors, such as training in use of the tool, changes in service focus
occurred during the audit timeframe.
T tool, associated hardware and connectivity which included the number, quality
he
and locality of computers. Some ‘ dead spots’ were identified.
Data collection limitations included:
•The PDA would ‘ crash’ as it was unable to hold the amount of data collected
•Access to equipment at times e.g. scales and height measure
•How to ask questions such as ethnicity and smoking.
L ack of standardisation of data collected. The data fields grew over time as the tool was
used more and some data fields were worded ambiguously and open to interpretation by
the nurse entering data.
Also some information requests were repeated. Due to the difficulties outlined above nurses
did not always fill in all the required fields.