Baseline Assessments
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Transcript of Baseline Assessments
Insert name of presentation on Master Slide
An introduction to the SKIN Bundleand its implementation
16th June 2010
Presenter: Nigel Broad Charge Nurse
Reduce the Percentage of Hospital acquired Pressure
Ulcers(per 1000 patient
days By 50% by
2010 Identification, grading
of pressure ulcers existing on admission /transfer & appropriate
intervention
Assess pressure ulcer risk on admission for ALL patients Re-assess skin every 8 hours where necessary Initiate and maintain correct and suitable preventative measures
Understand the risk factors for acquiring pressure ulcers Understand the local context & analyse local data to assess patients on ward/unit most at risk Utilise patient ‘At risk’ cards to quickly identify those at increased risk
Risk Assessment
Risk Identification
Reliable Implementation of the
SKIN ‘bundle’ ‘Ascension health’s
initiative 2004’
Address these areas: Surface Keep Moving Incontinence Nutrition
Initiate and maintain correct and suitable treatment measures Utilise the local Tissue Viability nursing expertise
Content Area Drivers Interventions
Educate staff regarding the assessment process, identification and classification of, and treatment of pressure ulcers Educate Patients & family Develop patient information pack
Education
An introduction to the SKIN Bundle and its Implementation
Baseline Assessments• Hospital: Pressure ulcer Incidence 8-13% • Pilot Ward (Anglesey):
– Baseline incidence rate - 4.5% – Nutritional assessment - 50%– Pressure risk assessment - 80%
Source: spot audit March ’08
An introduction to the SKIN Bundle and its Implementation
Preparation for Culture Change• Set up multi - professional project team• Staff Briefing and brainstorm• Develop ‘SKIN Bundle’ into communication
tool• Agree metrics• Educate staff with TVN support• Ensure PU prevention is given high priority
e.g. team briefing, posters, visual cues• Develop patient information leaflets• Patient involvement is essential
An introduction to the SKIN Bundle and its Implementation
What is the SKIN Bundle of care?Surface• Mattress and Cushion
Include safety checks• Sheet checks,
wrinkles etc.• Reassess Waterlow
score at least daily
Keep Moving• Reposition patient• Inspect skin• Encourage mobility• Written advice for
patient and carers
An introduction to the SKIN Bundle and its Implementation
What is the SKIN Bundle of care? Incontinence• Toileting assistance• Continence products• Seek specialist advice• Keep clean and dry
Nutrition• Nutritional risk tool• Follow instructions• Ensure optimal intake• Use of charts if
required• Keep well hydrated
An introduction to the SKIN Bundle and its Implementation
An introduction to the SKIN Bundle and its Implementation
Pilot ‘SKIN Bundle’• Address risk scoring documentation – set
100% compliance, daily review • Deming's PDSA methodology commence with
small client group: “Model for Improvement”• Audit SKIN bundle communication tool – daily• Make it part of the ward fabric
An introduction to the SKIN Bundle and its Implementation
Outcome measures [Metrics]• Document pressure ulcers of all grades (I – IV) on
Safety Cross• Count “days since last pressure ulcer developed on
this ward” and display on Safety Cross• Incident form for any ulcer grade II and above• Calculate rate per 1000 bed-days• Monthly audit compliance of risk assessments
An introduction to the SKIN Bundle and its Implementation
Safety Cross1 2
3 4
5
7 8 9 10 11 12
13 14 15 16 17 18
19 20 21 22 23 24
25 26
Days since last PU
27 28
___ days 29 30 31
No new PU
Ward acquired PU
Patient admitted with
PU
An introduction to the SKIN Bundle and its Implementation
Aim for success
• 100% compliance with risk score
• Manage the risk score consistently
• Use SKIN Bundle communication tool with Patient involvement
• Written patient information and education leaflets
An introduction to the SKIN Bundle and its Implementation
It is now an adverse event!Pressure ulcer occurred on Jan 25th 2010
1. Grade 2 PU
2. Incident form filled in as per policy
3. Outcome - PU healed within 4 days
4. Critical analysis took place
1. Was patient assessed properly
2. Had assessment plan been maintained
3. Could something have been done differently
An introduction to the SKIN Bundle and its Implementation
Keys factors – to success• Communication tool – patient partnership• Staff education and engagement – all staff groups
“Model for Improvement”• Create a “Culture of Change” not just about a document • Risk scoring and managing those scores• Tissue Viability Nursing support• Team approach with clear executive engagement
An introduction to the SKIN Bundle and its Implementation
Spreading the intervention• Plan and manage using a multi-professional project
team• Use cycles of change when required• Quick wins are important– success breeds success • Give yourself clear aims that are SMART
An introduction to the SKIN Bundle and its Implementation
ANY QUESTIONS?