Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury...
-
Upload
informa-australia -
Category
Health & Medicine
-
view
277 -
download
7
description
Transcript of Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury...
![Page 1: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/1.jpg)
Pressure Injury Prevention Project
Clinical Excellence Commission Maree Connolly
September 2014
A collaborative approach to pressure injury prevention in NSW
![Page 2: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/2.jpg)
Acknowledgement of Country
I would like to acknowledge the traditional custodians of the land on which we meet today, the Kulin Nation. I pay my respect to Elders past and present and to all Aboriginal and Torres Strait Islander people who are here today.
2
![Page 3: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/3.jpg)
Key drivers “It may be a strange principle to enunciate as the first requirement in a hospital that it should do the sick no harm.” Florence Nightingale, 1863
3
![Page 4: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/4.jpg)
Key drivers - Guidelines
Pan Pacific Clinical Practice Guidelines for the Prevention and Management of Pressure Injury 2012.
Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline 2014.
4
![Page 5: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/5.jpg)
Key Drivers
The Australian Commission on Safety and Quality in Health Care (ACSQHC) has recognised pressure injuries as the fifth most costly and commonly occurring preventable condition.
Jackson T, et al. Marginal costs of hospital-acquired conditions: information for priority-setting for patient safety
programmes and research. Journal of Health Services Research and Policy. Vol 16 No 3 July 2011
5
![Page 6: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/6.jpg)
Key Drivers: National Safety & Quality Health Service Standards (NSQHSS)
NSQHSS were introduced nationally on 1 January 2013
Standard 8: Preventing & Managing Pressure Injuries The intention of the Standard is to prevent patients from developing pressure injuries and effectively managing pressure injuries when they do occur.
6
![Page 7: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/7.jpg)
NSW Health
• NSW population - 7.3 million, with 4.6 million living in the Sydney metropolitan area
• NSW Health is the biggest public health
system in Australia
• 220 public hospitals
• Approximately 105,000 dedicated staff (FTE) make up the health workforce.
7
![Page 8: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/8.jpg)
NSW Health
8
![Page 9: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/9.jpg)
NSW Health On a typical week day in NSW:
• 17,000 people spend the night in a public hospital
• 6,500 people are seen in EDs
• 5,600 people are admitted to a public hospital
• 1,000 patients have their surgery (emergency or planned) performed in our public hospitals
All figures on this page are based on the 2012-2013 financial year.
9
![Page 10: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/10.jpg)
NSW Health: HIE ICD-10 coded data
10
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
2011
2012
2013
0
2,000
4,000
6,000
8,000
10,000
2011 2012 2013
PI C
ases
Pressure Injury Cases in NSW
Condition not noted on admission
Condition noted on admission
Not reported
![Page 11: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/11.jpg)
Cost to the Health System
11
![Page 12: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/12.jpg)
Clinical Excellence Commission
The Clinical Excellence Commission
is responsible for leading safety and quality
improvement in the NSW public health system
![Page 13: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/13.jpg)
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Steps to Excellence ? 2015 ?!?
![Page 14: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/14.jpg)
Collaborative Approach
Steering Committee A steering committee was established in January 2013 with representation from each LHD/SHN to progress work on pressure injury prevention
The steering committee is chaired by the Chief Nursing and Midwifery Officer Susan Pearce
14
![Page 15: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/15.jpg)
Collaborative Approach: Key partners
15
Patients,
families &
carers
![Page 16: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/16.jpg)
Collaborative Approach: Resource development
Policy Education eLearning modules
Monitoring and
Auditing Framework
Equipment Patient
information
16
![Page 17: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/17.jpg)
Collaborative Approach
17
![Page 18: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/18.jpg)
Resource Development http://www.cec.health.nsw.gov.au/programs/pressure-injury-prevention-project
18
![Page 19: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/19.jpg)
Resource Development: Policy
Revised Pressure Injury Prevention and Management policy PD2014_007 was released on 24 March 2014
19
![Page 20: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/20.jpg)
Resource Development: Policy Implementation Guide
• Facility implementation plan
• Action plan
• Risk assessment requirements
• Prevention strategies
• Prevention and management flowcharts
• Education for staff, patients, family and carers
• Monitoring and auditing framework
20
![Page 21: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/21.jpg)
Resource Development: Pressure Injury Prevention and Management Flowcharts
21
![Page 22: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/22.jpg)
Resource Development: eLearning Modules
22
![Page 23: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/23.jpg)
Resource Development: eLearning Module
23
![Page 24: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/24.jpg)
Resource Development: Monitoring & Auditing Framework
24
![Page 25: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/25.jpg)
Resource Development: Monitoring & Auditing Framework Point Prevalence Survey Documentation pack
25
![Page 26: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/26.jpg)
Resource Development: Monitoring & Auditing Framework Recommendations:
1. Conduct a point prevalence survey at least annually
- number of patients with PI at a specific time point
- concurrent audit of compliance with core aspects of preventive care.
2. Conduct a best practice clinical audit of care process documentation.
- collect regularly (frequency decided locally).
3.Regular monitoring of recorded PI incidence in each organisation using routinely collected data
- occurrence of new cases in an organisation.
26
![Page 27: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/27.jpg)
Resource Development: Patient Information Brochure
27
![Page 28: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/28.jpg)
Resource Development: Patient Information Brochure • There was consumer input in the development of the
brochure
• The brochure can be printed from the CEC Pressure Injury Prevention Project webpage
• Available in nine languages: English, Arabic, Greek, Traditional Chinese, Simplified Chinese, Hindi, Vietnamese, Korean and Italian
• The English version of the patient information brochure is available to order through Fuji Zerox Order Number NH606696 Cost pk50 $33.42+GST
28
![Page 29: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/29.jpg)
Resource Development
Agency for Clinical Innovation
Model of Care for Prevention and Integrated Management of Pressure Injuries in People with Spinal Cord Injury and Spina Bifida, http://www.aci.health.nsw.gov.au/models-of-care/scis-pressure-injury-moc
Guideline: Pressure Injury Prevention for Critically ill Adults available on IC-Wiki - an initiative of NSW Intensive Care Coordination and Monitoring Unit and part of NSW Agency for Clinical Innovation http://intensivecare.hsnet.nsw.gov.au/icwiki/index.php/Welcome_to_ICWiki
29
![Page 30: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/30.jpg)
Resource Development: Work in progress
Quality System Assessment (QSA) 2014
30
![Page 31: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/31.jpg)
Resource Development: Work in progress
New Information Management System
31
![Page 32: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/32.jpg)
Resource Development: Work in progress
Electronic Medical Record (eMR)
32
![Page 33: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/33.jpg)
Resource Development: Work in progress
Quality Audit Reporting System (QARS)
33
![Page 34: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/34.jpg)
Resource Development: Work in progress
Paediatric resources
34
![Page 35: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/35.jpg)
Patient focus
35
![Page 36: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/36.jpg)
Patient focus
36
“Pressure sores could be prevented by good nursing care” Florence Nightingale 1861
![Page 37: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/37.jpg)
Patient focus Many pressure injuries are preventable and it is recognised that their lengthy healing time has consequences for quality of life, including:
• Susceptibility to infection
• Pain
• Sleep and mood disturbance
Also:
• Impact on rehabilitation
• Mobility
• Long term quality of life
• Death
37
![Page 38: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/38.jpg)
Patient focus
38
![Page 39: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/39.jpg)
Next Steps: Data and Patient Stories
39
![Page 40: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/40.jpg)
Jake’s story - why we need to change
40
![Page 41: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/41.jpg)
41
![Page 42: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/42.jpg)
Jake’s story
Pressure damage resulted in 3 pressure wounds • left iliac crest • left greater trochanter • left ilium (right shoulder
pain prevented repositioning)
![Page 43: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/43.jpg)
Jake’s Story: Pressure Injury Impact • Bed rest for many months • High risk of sepsis • Complicated renal failure • Weight loss • High risk of autonomic dysreflexia • Mental health impact (social isolation) • Loss of confidence in the health system • Zero fun factor • Interruption to rehab and work • Reduced independence • Financial strain
43
![Page 44: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/44.jpg)
Jake’s Story: Organisational impact • Reputation
• Patient safety risk
• Cost of care
• Increased services
• Future litigation risk
• Long durations of On Stretcher Time (OST) adversely effects patients
The damage has been done and it is too late to rescue the ischaemic injury unrelieved pressure caused.
44
![Page 45: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/45.jpg)
Jake’s Story: Points for consideration
Pressure mapping indicates greater pressures are exerted over the sacrum when the head of the trolley is raised, regardless of the type of mattress in situ. Consider lying patient flat if not contraindicated from a medical point of view.
45
![Page 46: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/46.jpg)
Jake’s Story: Points for Consideration
Pressure Mapping of Sacrum Supine with 75 degrees of head elevation a) Trolley with standard mattress b) Trolley with Repose mattress on top of standard
46
![Page 47: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/47.jpg)
Jake’s Story: Points for consideration
Length of time spent on surfaces exerting high amounts of pressure cause adverse events with major consequences.
Jake’s story highlights the need for timely pressure care which must include early assessment and intervention in ED.
47
![Page 48: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/48.jpg)
DO NO HARM, KEEP OUR PATIENTS SAFE
48
![Page 50: Maree Connolly, Clinical Excellence Commision - A Collaborative Approach to Pressure Injury Prevention in NSW](https://reader034.fdocuments.in/reader034/viewer/2022051208/546d4760af795962298b5305/html5/thumbnails/50.jpg)
Thank you
50
For further information:
Maree Connolly
www.cec.health.nsw.gov.au