Early Identification of
Patients at Risk of a
Pressure Injury
Michelle Tuck
Clinical Nurse Consultant- Wound Management
Session focus
• Implementation of a pressure injury prevention round
• Introduction of a skin assessment tool
• Completion...
We have good processes for management of
pressure injuries…
…but how do we put the focus on
prevention?
Alfred Health
The Alfred Hospital, Caulfield Hospital and Sandringham
Hospital
– Acute and mental health services, rehabil...
Point Prevalence (time-series) - Alfred Health
30.7
26.8
20.3
16.2
17.0 16.6
14.8
11.0 10.7
13.2
0
5
10
15
20
25
30
35
200...
Trauma ward
The 2009 point prevalence was higher than any
other area in Alfred Health including ICU
2 West PUPPS Results
3...
Aims and Objectives
• To provide focus on prevention of pressure injuries
rather than the management of pre-existing injur...
Methodology
Run a weekly multidisciplinary pressure injury
prevention round.
The multidisciplinary team consists of :
CNC-...
Methodology
Discussion at the bedside:
• The patient’s pressure injury risk factors and current skin
integrity
• Current i...
Performance Indicator
• Monitor documentation of pressure injury
prevention plans through quarterly audits
• Future PUPPS ...
Baseline Data
• Previous PUPPS results
• 2W PIP Audit Results
‘Appropriate plan identified’:
Feb 2009 – 50%
June 2009 – 40...
Outcomes
2 West PIP Audit results
Appropriate plan documented
Feb 2010 – 50%
August 2010 – 40%
2 West PUPPS Results
10.53% 7.70%
11.63%
37% 38%
47%
28%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
2007 2008 2009 2010 201...
Considerations for the future
• A weekly summary sheet was developed following
several trials.
• The tool is recommended f...
Date / /
Patient Nurse
Is the
Braden
Score
current
?
Y/N
Risk
level
(H/M/L)
Are the
appropriate
allied health
members
invo...
Sustainability and Recommendations
•The resource nurse/ACN on the shift is encouraged to
lead the round.
•Capture and docu...
PUPPS Results at the Alfred
0
5
10
15
20
25
30
A B C D E F G H I J K L M N O Alfred
Hlth
Ward
Prevalence(%)
2010
2011
2012...
Introduction of a skin assessment tool and
completion of pressure injury prevention
plans based on risk assessment
Pressure Injury Prevention/
Management Guideline
Requirement All Patients Low Risk Patients Moderate-High
Risk Patients
Sk...
Pressure injury risk assessment
A 3 step process
1. Assess your patient’s skin
2. Assess your patient’s pressure injury ri...
Skin Assessment
• Skin Assessment
• Daily or once per shift
depending on Braden
• Within 8 hours of
admission
Braden Risk Assessment
Pressure Injury Prevention Plan
Mandatory for all patients
Determine plan
according to patient’s
risk factors for all
moderate to high risk
patients and initial and
date the appropr...
Resources
Pressure Injury Staging
Braden Definition of Rating Scale
Prevention is the Key!
Nutrition
Sheer
Friction
Comfy
Ears
Moisture
Mobility –
Turning
surfaces
Thank you
• Any questions?
Together we can all make a difference to prevent
pressure injuries!
Michelle Tuck, Alfred Health - Early Identification of Patients at Risk of a Pressure Injury
Michelle Tuck, Alfred Health - Early Identification of Patients at Risk of a Pressure Injury
Michelle Tuck, Alfred Health - Early Identification of Patients at Risk of a Pressure Injury
Upcoming SlideShare
Loading in …5
×

Michelle Tuck, Alfred Health - Early Identification of Patients at Risk of a Pressure Injury

657 views

Published on

Michelle Tuck, Clinical Nurse Consultant, Wound Management, Alfred Health 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
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
657
On SlideShare
0
From Embeds
0
Number of Embeds
6
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Michelle Tuck, Alfred Health - Early Identification of Patients at Risk of a Pressure Injury

  1. 1. Early Identification of Patients at Risk of a Pressure Injury Michelle Tuck Clinical Nurse Consultant- Wound Management
  2. 2. Session focus • Implementation of a pressure injury prevention round • Introduction of a skin assessment tool • Completion of pressure injury prevention plans based on risk assessment
  3. 3. We have good processes for management of pressure injuries… …but how do we put the focus on prevention?
  4. 4. Alfred Health The Alfred Hospital, Caulfield Hospital and Sandringham Hospital – Acute and mental health services, rehabilitation, aged care, residential care and community services, Women’s and Children’s Health. – Specialist services for trauma, emergency, intensive care • The Alfred is the state wide service for heart and lung replacement and transplantation, cystic fibrosis, burns, HIV/AIDS, haemophilia, sexual health, hyperbaric medicine.
  5. 5. Point Prevalence (time-series) - Alfred Health 30.7 26.8 20.3 16.2 17.0 16.6 14.8 11.0 10.7 13.2 0 5 10 15 20 25 30 35 2003 2004 2006 2007 2008 2009 2010 2011 2012 2013 Prevalence(%) Data including pressure injuries present on admission and hospital acquired
  6. 6. Trauma ward The 2009 point prevalence was higher than any other area in Alfred Health including ICU 2 West PUPPS Results 37% 38% 47% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 2007 2008 2009 Year PointPrevalence
  7. 7. Aims and Objectives • To provide focus on prevention of pressure injuries rather than the management of pre-existing injuries • Reduce the ward pressure injury point prevalence • Increase staff awareness regarding pressure injury prevention strategies • Improve documentation of pressure prevention plans
  8. 8. Methodology Run a weekly multidisciplinary pressure injury prevention round. The multidisciplinary team consists of : CNC- Wound Management, 2 West CS&DN/CNM, Podiatry, Nutrition, Manager of Inpatient Medical Equipment and Occupational Therapy.
  9. 9. Methodology Discussion at the bedside: • The patient’s pressure injury risk factors and current skin integrity • Current implemented pressure injury prevention strategies • Additional pressure injury prevention strategies Where appropriate patients are encouraged to participate
  10. 10. Performance Indicator • Monitor documentation of pressure injury prevention plans through quarterly audits • Future PUPPS results
  11. 11. Baseline Data • Previous PUPPS results • 2W PIP Audit Results ‘Appropriate plan identified’: Feb 2009 – 50% June 2009 – 40% October 2009 – 20%
  12. 12. Outcomes 2 West PIP Audit results Appropriate plan documented Feb 2010 – 50% August 2010 – 40%
  13. 13. 2 West PUPPS Results 10.53% 7.70% 11.63% 37% 38% 47% 28% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 2007 2008 2009 2010 2011 2012 2013 Year PointPrevalence
  14. 14. Considerations for the future • A weekly summary sheet was developed following several trials. • The tool is recommended for tracking weekly data.
  15. 15. Date / / Patient Nurse Is the Braden Score current ? Y/N Risk level (H/M/L) Are the appropriate allied health members involved? Y/N Does the patient have pressure injuries? Record location and stage Is there a PIP plan documented in the past 5 days? Y/N Are the current strategies in place appropriate and implemented ? Recommendations made by the round FOLLOW -UP Was the PIP plan written up? FOLLOW- UP Were the recomme nded interventi ons implemen ted? 2W PIP Round
  16. 16. Sustainability and Recommendations •The resource nurse/ACN on the shift is encouraged to lead the round. •Capture and document recommendations •Clarify who is to follow up post round •Review of weekly summary sheet •All staff to be involved at the commencement of each round
  17. 17. PUPPS Results at the Alfred 0 5 10 15 20 25 30 A B C D E F G H I J K L M N O Alfred Hlth Ward Prevalence(%) 2010 2011 2012 2013
  18. 18. Introduction of a skin assessment tool and completion of pressure injury prevention plans based on risk assessment
  19. 19. Pressure Injury Prevention/ Management Guideline Requirement All Patients Low Risk Patients Moderate-High Risk Patients Skin Assessment <8 hours of admission Daily Once per shift Pressure Injury Risk Assessment <8 hours of admission Daily Daily ICU – Once per shift ICU – Once per shift Documented Pressure Injury Prevention Plan <24 hours of admission At least every 5 days and following significant change in patient’s condition At least every 5 days and following significant change in patient’s condition Document effectiveness of interventions in Inpatient Progress Notes At least daily At least daily At least daily
  20. 20. Pressure injury risk assessment A 3 step process 1. Assess your patient’s skin 2. Assess your patient’s pressure injury risk The Braden Scale for Predicting Pressure Sore Risk 3. Document a Pressure Injury Plan
  21. 21. Skin Assessment • Skin Assessment • Daily or once per shift depending on Braden • Within 8 hours of admission
  22. 22. Braden Risk Assessment
  23. 23. Pressure Injury Prevention Plan Mandatory for all patients
  24. 24. Determine plan according to patient’s risk factors for all moderate to high risk patients and initial and date the appropriate strategies Observe bedside to ensure strategies are implemented Staff sign patient involved in discussion
  25. 25. Resources Pressure Injury Staging Braden Definition of Rating Scale
  26. 26. Prevention is the Key! Nutrition Sheer Friction Comfy Ears Moisture Mobility – Turning surfaces
  27. 27. Thank you • Any questions? Together we can all make a difference to prevent pressure injuries!

×