0
Update:
Improved Woundcare Program
Australia
September 2013
Terri Antonio
Consultant
Nursing Practice Solutions Inc.
Session Agenda
• Chronic Disease & Woundcare
• Industry Changes & Challenges
• An Integrated Solution to Wound Management
...
Chronic Disease & Wounds
• The impact of chronic conditions on Australians is considerable
• Where do chronic wounds fit?
...
Industry & Governance Changes
National Safety & Quality Health Services Standards (ACSQHC)
• Standard 8: Preventing & Mana...
Standard 8: Preventing & Managing Pressure Injuries
Governance and
systems for the
prevention and
management of
pressure i...
Challenges in the Hospital Environment
Human Costs
• Patient safety
• Infections (e.g. MRSA)
Economic Costs
• Length of st...
Program Stages
Independent Audit & Baseline Report
• Tailored report with distribution rates for all wounds
• Staff knowle...
Nurse Sensitive Outcome Measures
Clinical Audit Findings (inpatient data)
Clinical Audit:
• 19 Health Services – Admitted Patient/resident data
• Number of...
Clinical Audit Findings
Clinical Audit:
• 19 Health Services – Admitted Patient/resident data
• Number of survey participa...
Program Resources
• Education Program
– Curriculum
– Materials
– Train-the-Trainer
• Wound Care Chart
– TIME principles
– ...
Education Outcomes
Training Program
• Pre & Post Training Knowledge Assessment (Modules 1-3)
• Combined outcomes from part...
Outcomes: 3 months
Wimmera Health Care Group (WHCG)
• 43 trainers:
– Continuing monthly education sessions to capture
staf...
Outcomes: 12-18 months
Facility Acquired Pressure Injury Point Prevalence:
Reductions in PIPPS for services 12-18 months p...
Outcomes: 12-18 months
Severity of Injury:
Reductions in severity of Pressure Injury 12-18 months post implementation
Bena...
Outcomes: 12-18 months
Frequency of dressing changes:
Reduction in the number of wounds dressed daily 12-18 months post
im...
Outcomes: 3 Years
Ballarat Health Services Pressure Injury Point Prevalence:
Acute SubAcute Residential Total
11% 26% 9% 1...
Outcomes
3 Months:
• Improved awareness, knowledge, focus, systems and
monitoring
1 Year:
• Reduced facility acquired Pres...
BHS: Operational – Program Outcome
Ballarat
Health
Services
Acute
Separations
Pressure
Injury Point
Prevalence
Estimated
A...
Looking to the Future
Self Management Program
The integration of client self-management and empowerment into the
wound car...
QUESTIONS?
Terri Antonio
Consultant Nursing Practice Solutions Inc.
Phone: 0478 789 114
Email: terri@nursingpracticesoluti...
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Terri Antonio, Ballarat Health Services - The Progress of the ICS Improved Wound Care and Pressure Injury Prevention Program

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Terri Antonio, Director of Nursing, Women and Children's Services & Clinical Nurse Consultants, Ballarat Health Services 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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Transcript of "Terri Antonio, Ballarat Health Services - The Progress of the ICS Improved Wound Care and Pressure Injury Prevention Program"

  1. 1. Update: Improved Woundcare Program Australia September 2013 Terri Antonio Consultant Nursing Practice Solutions Inc.
  2. 2. Session Agenda • Chronic Disease & Woundcare • Industry Changes & Challenges • An Integrated Solution to Wound Management • Audit, Implementation, Measurement & Reporting • Progress and Outcomes • Questions/Discussion
  3. 3. Chronic Disease & Wounds • The impact of chronic conditions on Australians is considerable • Where do chronic wounds fit? – Chronic wounds are associated with co-morbid chronic diseases: • Pressure injuries (Multiple co-morbidities) • Diabetic foot ulcers (Diabetes) • Post surgical infected wounds (Multiple co-morbidities) • Peripheral vascular disease (Cardiac) • Leg ulcers (Venous disease) • Arterial ulcers (Congestive heart, COPD etc) • Malignant wounds (Cancer)
  4. 4. Industry & Governance Changes National Safety & Quality Health Services Standards (ACSQHC) • Standard 8: Preventing & Managing Pressure Injuries • “Health Service organisations have governance structures and systems in place for the prevention and management of pressure ulcers” • “An evidence-based wound management system is in place within the health service organisation” • Full implementation of new standards commenced January 2013 Activity Based Funding for Australian Public Hospitals (IHPA) • Set weighted activity payment for all procedures – Adverse quality performance will not be modelled or funded • e.g. pressure injuries, surgical site infections, catheter-associated infections – Efficient hospitals will benefit financially
  5. 5. Standard 8: Preventing & Managing Pressure Injuries Governance and systems for the prevention and management of pressure injuries 8.1 Developing and implementing policies, procedures and/or protocols that are based on current best practice guidelines 8.2 Using a risk assessment framework and reporting systems to identify, investigate and take action to reduce the frequency and severity of pressure injuries 8.3 Undertaking quality improvement activities to address safety risks and monitor the systems that prevent and manage pressure injuries 8.4 Providing or facilitating access to equipment and devices to implement effective prevention strategies and best practice management plans Preventing Pressure Injuries 8.5 Identifying risk factors for pressure injuries using an agreed screening tool for all presenting patients within timeframes set by best practice guidelines 8.6 Conducting a comprehensive skin inspection in timeframes set by best practice guidelines on patients with a high risk of developing pressure injuries at presentation, regularly as clinically indicated during a patient’s admission, and before discharge 8.7 Implementing and monitoring pressure injury prevention plans and reviewing when clinically indicated Managing Pressure Injuries 8.8 Implementing best practice management and ongoing monitoring as clinically indicated Communicating with Patients and Carers 8.9 Informing patients with a high risk of pressure injury, and their carers, about the risks, prevention strategies and management of pressure injuries 8.10 Developing a plan of management in partnership with patients and carers
  6. 6. Challenges in the Hospital Environment Human Costs • Patient safety • Infections (e.g. MRSA) Economic Costs • Length of stays • Lengthy discharge • Hospital waiting lists • Funding (e.g. cover for PI’s?) • Use of finite resources
  7. 7. Program Stages Independent Audit & Baseline Report • Tailored report with distribution rates for all wounds • Staff knowledge needs assessment • Planning Day with cross-functional representation Protocol Implementation, Training & Education • All staff trained to deliver consistent wound care • Uses adult learning principles & evidence based curriculum • Train-the-Trainer model Program Tools, Resources, Measurement & Reporting • Revised documentation and quality reporting • Multi-disciplinary committee to manage ongoing
  8. 8. Nurse Sensitive Outcome Measures
  9. 9. Clinical Audit Findings (inpatient data) Clinical Audit: • 19 Health Services – Admitted Patient/resident data • Number of survey participants: – 2,274 • Survey benchmark – Demographics Age Female Diabetic Insulin Dependent Incontinent Braden LOS 77 years 65% 22% 39% 54% 14 23 months
  10. 10. Clinical Audit Findings Clinical Audit: • 19 Health Services – Admitted Patient/resident data • Number of survey participants: – 2,274 • Survey benchmark Nurse Sensitive Outcomes Pressure Injury Distribution Daily Dressings Facility Acquired PIPP Heels Coccyx Buttock Foot Ankle 23% 15.7% 39% 17% 15% 12% 8%
  11. 11. Program Resources • Education Program – Curriculum – Materials – Train-the-Trainer • Wound Care Chart – TIME principles – Integrated with Education & Formulary • Integrated Care Pathways – Pressure Injury Prevention & Management
  12. 12. Education Outcomes Training Program • Pre & Post Training Knowledge Assessment (Modules 1-3) • Combined outcomes from participating Health Services Knowledge Domain Pre Training Benchmark Post Training Results Improvement Factors leading to Pressure Injury 94% 98% 2% Moist wound healing 84% 97% 13% Interventions for preventing Pressure Injury 80% 95% 15% Povidone Iodine, indications for use 68% 91% 23% Contraindications for debridement 66% 92% 26% Dressing choice 43% 89% 46% Elements of best practice wound care 38% 90% 52% Concept of wound contamination 35% 90% 55% Managing bacteria in the wound 38% 99% 61% TIME principles 7% 100% 93%
  13. 13. Outcomes: 3 months Wimmera Health Care Group (WHCG) • 43 trainers: – Continuing monthly education sessions to capture staff missed in the initial training • Classroom & ward level – Conducting audits on PI prevalence, documentation of wound charts, risk screens, prevention plans • Audit tools on survey monkey – instant data accessible • Monthly calendar established with monthly “themes” in relation to PI prevention and wound management • Equipment audits conducted: gap analysis, mattress audits – to strategically plan for new equipment WHCG Priority Ward PIPP decreased by 28% in 3 months
  14. 14. Outcomes: 12-18 months Facility Acquired Pressure Injury Point Prevalence: Reductions in PIPPS for services 12-18 months post implementation Benalla Health -73% Goulburn Valley Health -14% Northeast Health Wangaratta -20% Ballarat Health Services -45%
  15. 15. Outcomes: 12-18 months Severity of Injury: Reductions in severity of Pressure Injury 12-18 months post implementation Benalla Health -47% Goulburn Valley Health -58% Northeast Health Wangaratta -58%
  16. 16. Outcomes: 12-18 months Frequency of dressing changes: Reduction in the number of wounds dressed daily 12-18 months post implementation Benalla Health -50% Goulburn Valley Health -40% Northeast Health Wangaratta -65% Ballarat Health Services -88%
  17. 17. Outcomes: 3 Years Ballarat Health Services Pressure Injury Point Prevalence: Acute SubAcute Residential Total 11% 26% 9% 11% 9% 11% 5% 6% 2.5% 8% 3% 3.7%
  18. 18. Outcomes 3 Months: • Improved awareness, knowledge, focus, systems and monitoring 1 Year: • Reduced facility acquired Pressure Injury Point Prevalence • Reduced Severity of Pressure Injury • Reduced Frequency of Dressing Change 3 Years: Sustained improvements across all nurse sensitive outcomes
  19. 19. BHS: Operational – Program Outcome Ballarat Health Services Acute Separations Pressure Injury Point Prevalence Estimated Additional Bed Days Estimated Bed Day Savings (cumulative) 2009 Benchmark 33,607 11% 13,456 Nil 2011 34,909 9% 11,436 2,020 2012 36,531 2.5% 3,324 10,132
  20. 20. Looking to the Future Self Management Program The integration of client self-management and empowerment into the wound care program helps to place the client at the center of care decisions and support development of a true client-centered care delivery model. Incorporating: • Education to promote self-management • Client health record ‘health passport’ • Timely follow-up with primary/specialty care • A list of ‘red flags’ indicative of worsening condition and how to respond
  21. 21. QUESTIONS? Terri Antonio Consultant Nursing Practice Solutions Inc. Phone: 0478 789 114 Email: terri@nursingpracticesolutions.com
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