Downloaded 24 times
Uploaded bySCGH ED CME
Wound Care SCGH
This document provides information and guidance on wound care products and pressure injury management from Nicole Walsh, a Nurse Practitioner in Wound Management. It discusses dressing products like Mepitel silicon mesh and calcium alginate for skin tears. It also summarizes pressure injury data from SCGH in 2014, finding a prevalence of 5.3%, lower than the state average of 5.7% but higher than previous years. Key findings were gaps in skin assessment documentation and a lack of identified pressure injuries being documented in patient notes. Prevention strategies are needed to improve documentation and reduce injury rates.
More Related Content
More from SCGH ED CME
Wound Care SCGH
- 1. SCGH Wound CareProducts and General Advice Nicole Walsh, Nurse Practitioner Wound Management
- 2. Lola’s story –Traumatic Skin Tear Please tell my story • First documented inspection of skin- at 36 hrs • Frail / Fragile skin • Pain and suffering
- 3. Identification of Riskof Injury
- 4. • STAR Staging •NPGL • Gently roll out any clots • Approximate edges • No sutures/staples • No steri stripes • No adherent dressings • No adherent tapes.
- 5. • Use softsilicon mesh eg Mepitel, • Apply so onto healthy skin • It is a very tacky dressing non adherent silicon • Moistening your cotton bud
- 6. Calcuim Alginate • Flatsheet of Calcuim Alginate if bleeding continues to assist with Haemostasis • Goes over top of Mepitel and is removed gently by irrigating with normal saline in 24 hrs. • Mepitel remains in situ
- 9. Pressure Injury orSkin Tear Alert Sticker It has been introduced to: • Alert staff of an identified pressure injury or skin tear • Ensure each injury is appropriately classified and clearly documented in the notes – to support clinical coders. • Ensure injuries are accurately coded so that the hospital does not lose funds in relation to the ABM/ABF model. • Improve reporting of injuries to inform prevention strategies for the future
- 10. Mepilex Boarder Flex •Oval shaped all-in-one foam dressing – easy to use and fits body contours • Absorbent pad with flex technology – very flexible and conformable • Less painful for patients at dressing changes – less stress for patients, easier care • Atraumatic to the wound and surrounding skin at dressing removal3 – undisturbed healing • Excellent exudate management – reduced risk of leakage and maceration
- 11. Mepilex Boarder Heel All-in-onedressing shaped to fit the heel – easy to use, time-saving dressing changes • Atraumatic to the wound and to the surrounding skin at removal1 – undisturbed healing
- 12.
- 13. Melgisorb Ag Silver-containing alginate Providessustained antimicrobial effect • Suitable for high exuding wounds • Designed for shallow and deep wounds • Allows removal in one piece
- 14. 0 5 10 15 20 25 30 35 CIM'S Data RecordedPressure Injuries Not Present on Admission Present on Admission Unknown if present on admission Total
- 15. Pressure Injuries –July to December CIMS Stage 1 - non- blanchable erythema Stage 2 - partial thickness skin loss Stage 3 - full thickness Suspected deep tissue injury - depth unknown Unknown Unstageable - depth unknown Total Jul 6 3 0 0 1 0 10 Aug 9 4 1 1 3 0 18 Sep 6 9 0 0 1 0 16 Oct 7 5 0 0 1 0 13 Nov 6 5 0 0 1 1 13 Dec 7 4 0 0 0 0 11 Total 41 30 1 1 7 1 81
- 16. SCGH - WoundManagement Product changes Product Removed Replaced by Company Calcium Alginate Ribbon Kaltostat Rope • Calcium Alginate Biatain Alginate Coloplast Calcium Alginate with Ag Silvercel • Calcium Alginate with Ag Melgasorb Ag Molnlycke Post Island Dressing Opsite Cutiplast • Tegaderm Island • Mepore Island Tape & Film • Mepilex Island 3M Molnlycke Absorbent Pads Relevo ( Drymax ) • Zetuvit Plus • Exudry Hartmann Smith & Nephew Tapes Transpore Yuki Ban • Blenderm • Kind Remove Silicone Tape 3M Hydro Capillary Alione Vacutex Not replaced
- 17. Additions New productsAdditional Information Company Soft Silicon Foam Mepilex Heel shaped – non adhesive Also comes in contoured heel shaped/ adhesive May be re used if skin intact. Hold insitu with TED stocking/tubular band/non slip sock Consider for very restless patients Molnlycke Hydro Fibres – Ribbon sizes Aquacel Ribbon Strengthening fibres Now comes in a 1cm for narrow sinus’s as well as 2cm Convatec Skin Barrier Cream Cavilon – more extensive range found on continence contract Barrier cream, single use sachets, wipes, paddles & spray’s 3M
- 18. Product Types ofdressings Additional Information Company Silicon Foam Mepilex range Prophylactic dressing can be lifted for skin inspection and reapplied Molnlycke Gels Intrasite Conformible Hydrosorb gel sheet available dressing bank Smith & Nephew Hartmann Antimicrobials • AMD non adherent • AMD Foam High risk patient only Coviden Antimicrobial •Inadine •Iodosorb ointment •Iodosorb powder Smith & Nephew Silver Dressings Atrauman Ag Aquacel Ag Melgasorb Ag Acticoat Mepilex Ag Biatain Ag Ag Tulle Ag Hydro Fibre Ag Calcium Alginate Ag Flex /Cloth Ag Silicon Foam Ag Foam Hartmans Coviden Molnlycke Smith & Nephew Molnlyke Coloplast
- 19. SCGH Pressure InjuryPrevalence Data 2007 2008 2009 2011 2013 2014 RPH 10 9 6 8 6 SCGH 10.5 10 8 9 8.9 3.4 STATE AV 8 9 6 7.4 0 2 4 6 8 10 12 P.I Prevalence Data: May 2007 -2014 RPH and SCGH comparison Grade 2 5.3% Total 11 % 2014 State Wide data : Total No Patients : 2974 Total No HAPI : 5.7% Excluding Stage 1 : 2.2% SCGH Total No Patients : 445 Total No HAPI : 5.3% Excluding Stage 1 : 3.4%
- 20. Key Information fromthe 2014 pressure injury prevalence data • 79.6% of patients on the day had a skin inspection • Braden scores indicated that 42.9% of patients were identified at risk (either moderate- high risk) of developing a pressure injury. This equates to 202 patients on the day. • Currently we have 185 air mattresses in the hospital – 115 for high to very high risk patients – 70 for moderate / at risk patients • 72.1% of patients had a skin assessment documented within 8 hours of admission. • 12% of the patients with a pressure injury were recorded as device related e.g. IDC, nasal prongs
- 21. Key Information fromthe 2014 pressure injury prevalence data • 49% of patients assessed with a pressure injury did not have any documentation in the medical or nursing notes identifying a pressure injury • The patients that were identified as having a pressure injury 56.1% had more than one • Evidence shows that 50% stage one pressure injuries develop into stage 2 and 3