NATIONAL STANDARD 8
PREVENTING AND MANAGING PRESSURE INJURY
Matthew Wilson
Sutherland Hospital
PREVENTING AND MANAGING
PRESSURE INJURY
Pressure Ulcer
Development
Pressure
Impaired Mobility
Impaired Activity
Impaired Sensory
Perception
Extrinsic Factors
Intr...
Support Surfaces
Skin Inspections
Erythema,
Elanching response
Localised heat
Oedema
Induration
Skin breakdown.
STAGE 1
STAGE I PRESSURE INJURY: NON-
BLANCHABLE ERYTHEMA
Intact skin with non-blanchable redness of a localised
area usually over...
Stage 1
STAGE 2
STAGE II PRESSURE INJURY: PARTIAL
THICKNESS SKIN LOSS
Partial thickness loss of dermis presenting as a
shallow, open wound...
Stage 2
Stage 2
STAGE 3
STAGE III PRESSURE INJURY: FULL
THICKNESS SKIN LOSS
Full thickness tissue loss. Subcutaneous fat may
be visible but bone, ...
Stage 3
STAGE 4
STAGE IV PRESSURE INJURY: FULL
THICKNESS TISSUE LOSS
Full thickness tissue loss with exposed bone,
tendon or muscle. Sloug...
Stage 4
SUSPECTED DEEP TISSUE INJURY
SUSPECTED DEEP TISSUE INJURY:
DEPTH UNKNOWN
Purple or maroon localised area or discoloured,
intact skin or blood-filled bl...
Suspected Deep Tissue Injury
SUSPECTED DEEP TISSUE INJURY
Suspected Deep Tissue Injury
UNSTAGEABLE PRESSURE INJURY:
DEPTH UNKNOWN
Full thickness tissue loss in which the base of the
PI is covered by slough (ye...
Unstageable
Unstageable
10 NATIONAL STANDARDS
NATIONAL STANDARD 8
Governance and systems
Preventing pressure injury
Managing pressure injury
Communicating with patients...
Benefits of Standard 8
Reduce avoidable pressure injuries
Reduce cost for the organisation/state health
department
Bring n...
Where to start
Identify key stakeholders
Executive support
Perform gap analysis
Meet with key stakeholders
Distribute task...
GOVERNANCE AND SYSTEMS
Hospital Pressure Injury Prevention Committee
Review of incident data (IIMS)
Review of polices and ...
GOVERNANCE AND SYSTEMS
Best practice clinical audits
Risk assessment
Skin assessments
Prevention plans
Management plans
Co...
IIMS STICKER
IIMS
IIMS – Waterlow Score & SAC Score
Waterlow Scores
No risk less than 5
Low risk less than 10
Medium risk 10 +
High risk 15 ...
Guidelines for SAC Scores
New pressure ulcer including
↑ length of stay
and/or
Requires surgery on pressure injury
Any new...
GOVERNANCE AND SYSTEMS
Point prevalence audits
Prevalence
Hospital acquired pressure injury
Grade of pressure injury
Water...
Other sources of pressure injury data
Coded data through clinical information
Simple monthly reports can be run
Coders nee...
PREVENTING PRESSURE INJURY
New 7 day Waterlow review form
Mattress system
Waterlow competence
Pt's are given information b...
Highlight quality activities
Gurada heel introduced into operating theaters
Waterlow, skin inspection and mattress add to
...
MANAGING PRESSURE INJURY
New Wound Chart
Wound care best practice
Closer relationships with facilities on D/C
COMMUNICATING WITH PATIENTS AND
CARERS
Patient and/or carer aware tick box on multiple
forms such as Wound Chart and 7 Wat...
How to maintain change
Feedback to key stakeholders
Feedback to nursing staff at ward level
Be transparent with results
IN SUMMERY
Don’t panic
Work through standard 8 systematically
Establish group of stakeholders
Move now to fill gaps in pra...
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
Matthew Wilson, The Sutherland Hospital - Meeting Standard 8, Our Experience
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.

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

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

  1. 1. NATIONAL STANDARD 8 PREVENTING AND MANAGING PRESSURE INJURY Matthew Wilson Sutherland Hospital
  2. 2. PREVENTING AND MANAGING PRESSURE INJURY
  3. 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. 4. Support Surfaces
  5. 5. Skin Inspections Erythema, Elanching response Localised heat Oedema Induration Skin breakdown.
  6. 6. STAGE 1
  7. 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. 8. Stage 1
  9. 9. STAGE 2
  10. 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. 11. Stage 2
  12. 12. Stage 2
  13. 13. STAGE 3
  14. 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. 15. Stage 3
  16. 16. STAGE 4
  17. 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. 18. Stage 4
  19. 19. SUSPECTED DEEP TISSUE INJURY
  20. 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. 21. Suspected Deep Tissue Injury
  22. 22. SUSPECTED DEEP TISSUE INJURY Suspected Deep Tissue Injury
  23. 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. 24. Unstageable
  25. 25. Unstageable
  26. 26. 10 NATIONAL STANDARDS
  27. 27. NATIONAL STANDARD 8 Governance and systems Preventing pressure injury Managing pressure injury Communicating with patients and carers
  28. 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. 29. Where to start Identify key stakeholders Executive support Perform gap analysis Meet with key stakeholders Distribute task amongst key stakeholders
  30. 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. 31. GOVERNANCE AND SYSTEMS Best practice clinical audits Risk assessment Skin assessments Prevention plans Management plans Consumer engagements
  32. 32. IIMS STICKER
  33. 33. IIMS
  34. 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. 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. 36. GOVERNANCE AND SYSTEMS Point prevalence audits Prevalence Hospital acquired pressure injury Grade of pressure injury Waterlow Mattresses Wound assessment form
  37. 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. 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. 39. Highlight quality activities Gurada heel introduced into operating theaters Waterlow, skin inspection and mattress add to clinical handover
  40. 40. MANAGING PRESSURE INJURY New Wound Chart Wound care best practice Closer relationships with facilities on D/C
  41. 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. 42. How to maintain change Feedback to key stakeholders Feedback to nursing staff at ward level Be transparent with results
  43. 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
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