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Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
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Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience

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Matthew Wilson, Wound Care Clinical Nurse Consultant, The Sutherland Hospital delivered the presentation at 2013 Reducing Avoidable Pressure Injuries Conference. …

Matthew Wilson, Wound Care Clinical Nurse Consultant, The Sutherland Hospital delivered the presentation at 2013 Reducing Avoidable Pressure Injuries Conference.

The 2013 Reducing Avoidable Pressure Injuries Conference featured a comprehensive case study led program covering topics such as prevention of pressure injuries during the surgical patient journey and in people with Spinal Cord Injuries, meeting Standard 8, translating research into clinical practice and more.

For more information about the event, please visit: http://www.informa.com.au/pressureinjuries13

Published in: Healthcare

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  • 1. NATIONAL STANDARD 8 PREVENTING AND MANAGING PRESSURE INJURY Matthew Wilson Sutherland Hospital
  • 2. PREVENTING AND MANAGING PRESSURE INJURY
  • 3. Pressure Ulcer Development Pressure Impaired Mobility Impaired Activity Impaired Sensory Perception Extrinsic Factors Intrinsic Factors Moisture Friction Demographics Oxygen Delivery Skin Temperature Chronic Illness Shear Nutrition Tissue Tolerance Source: Final Draft - Clinical Practice Guidelines for the Prevention of Pressure Ulcers, March 1999
  • 4. Support Surfaces
  • 5. Skin Inspections Erythema, Elanching response Localised heat Oedema Induration Skin breakdown.
  • 6. STAGE 1
  • 7. STAGE I PRESSURE INJURY: NON- BLANCHABLE ERYTHEMA Intact skin with non-blanchable redness of a localised area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its colour may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler compared to adjacent tissue. May be difficult to detect in individuals with dark skin tones.
  • 8. Stage 1
  • 9. STAGE 2
  • 10. STAGE II PRESSURE INJURY: PARTIAL THICKNESS SKIN LOSS Partial thickness loss of dermis presenting as a shallow, open wound with a red-pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Presents as a shiny or dry, shallow ulcer without slough or bruising
  • 11. Stage 2
  • 12. Stage 2
  • 13. STAGE 3
  • 14. STAGE III PRESSURE INJURY: FULL THICKNESS SKIN LOSS Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunnelling
  • 15. Stage 3
  • 16. STAGE 4
  • 17. STAGE IV PRESSURE INJURY: FULL THICKNESS TISSUE LOSS Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed.
  • 18. Stage 4
  • 19. SUSPECTED DEEP TISSUE INJURY
  • 20. SUSPECTED DEEP TISSUE INJURY: DEPTH UNKNOWN Purple or maroon localised area or discoloured, intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue. Deep tissue injury may be difficult to detect in individuals with dark skin tone.
  • 21. Suspected Deep Tissue Injury
  • 22. SUSPECTED DEEP TISSUE INJURY Suspected Deep Tissue Injury
  • 23. UNSTAGEABLE PRESSURE INJURY: DEPTH UNKNOWN Full thickness tissue loss in which the base of the PI is covered by slough (yellow, tan, grey, green or brown) and/or eschar (tan, brown or black) in the PI bed. Until enough slough/eschar is removed to expose the base of the PI, the true depth, and therefore the stage, cannot be determined.
  • 24. Unstageable
  • 25. Unstageable
  • 26. 10 NATIONAL STANDARDS
  • 27. NATIONAL STANDARD 8 Governance and systems Preventing pressure injury Managing pressure injury Communicating with patients and carers
  • 28. Benefits of Standard 8 Reduce avoidable pressure injuries Reduce cost for the organisation/state health department Bring nurses/allied health to the forefront Potential increase of specialist wound care positions
  • 29. Where to start Identify key stakeholders Executive support Perform gap analysis Meet with key stakeholders Distribute task amongst key stakeholders
  • 30. GOVERNANCE AND SYSTEMS Hospital Pressure Injury Prevention Committee Review of incident data (IIMS) Review of polices and procedures R/V of educational requirements R/V of current issues
  • 31. GOVERNANCE AND SYSTEMS Best practice clinical audits Risk assessment Skin assessments Prevention plans Management plans Consumer engagements
  • 32. IIMS STICKER
  • 33. IIMS
  • 34. IIMS – Waterlow Score & SAC Score Waterlow Scores No risk less than 5 Low risk less than 10 Medium risk 10 + High risk 15 + Very high risk 20 + SAC Score
  • 35. Guidelines for SAC Scores New pressure ulcer including ↑ length of stay and/or Requires surgery on pressure injury Any new grade 3 and 4 pressure injury SAC 2 New pressure injury Doesn’t ↑ length of stay or Dosen’t require surgery on pressure injury SAC 3 Admitted to the health service with an existing pressure injury SAC 4
  • 36. GOVERNANCE AND SYSTEMS Point prevalence audits Prevalence Hospital acquired pressure injury Grade of pressure injury Waterlow Mattresses Wound assessment form
  • 37. Other sources of pressure injury data Coded data through clinical information Simple monthly reports can be run Coders need to be trained around new pressure injury staging system
  • 38. PREVENTING PRESSURE INJURY New 7 day Waterlow review form Mattress system Waterlow competence Pt's are given information brochures on pressure injury prevention.
  • 39. Highlight quality activities Gurada heel introduced into operating theaters Waterlow, skin inspection and mattress add to clinical handover
  • 40. MANAGING PRESSURE INJURY New Wound Chart Wound care best practice Closer relationships with facilities on D/C
  • 41. COMMUNICATING WITH PATIENTS AND CARERS Patient and/or carer aware tick box on multiple forms such as Wound Chart and 7 Waterlow Review chart Move towards notifying pt/carers when IIMS incident is logged Pressure Injury Prevention Handouts are available for all patients
  • 42. How to maintain change Feedback to key stakeholders Feedback to nursing staff at ward level Be transparent with results
  • 43. IN SUMMERY Don’t panic Work through standard 8 systematically Establish group of stakeholders Move now to fill gaps in practice and resources Communicate with other hospitals to pool resources