Melissa Ward - Sydney Adventist Hospital - Pressure Injury Prevention-Embracing Technology at Sydney...
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Transcript of Melissa Ward - Sydney Adventist Hospital - Pressure Injury Prevention-Embracing Technology at Sydney...
Pressure Injury Prevention-
Embracing Technology at
Sydney Adventist Hospital
Melissa Ward RN CNE - SAH
Cert IV TAE
Grad Cert Wound Care (Monash)
Sydney Adventist Hospital
Content
• Hospital wide issues experienced with changing to
electronic documentation
• Using electronic pathways to correctly risk assess
patients
• Ensuring prevention strategies are not “lost in
translation”
• Using technology to assist with education
In the olden days…
E-pathways
• Working parties formed on each ward and
specialty areas to create electronic clinical
pathways for the majority of patient conditions
and surgical procedures.
• General medical, General Surgical which would
outline standard tasks the nurses had to perform:
– 4/24 obs
– Daily risk assessment screen on Braden and falls
– Mobility assessment
– Pre-op assessments
• The nurses could then add in additional
pathways/activities to individualise the care e.g.
respiratory pathway, orthopaedic
knee/hip/shoulder, neurosurgical –
lumbar/cervical, or oncology pathway.
• Or specific therapies/obs – such as blood
transfusion/iron infusion/PCA etc
Electronic documentation
• Transition to electronic documentation began in
October 2012.
• Huge undertaking
• Ward by ward roll out
• Creation of 5 e-Learning training modules
• Training of super users to assist with change and
acceptance
• Supernummary super users on all shifts for 1 week.
Issues with PI risk assessment and
preventative strategies
• Braden was required to be done daily on all
patients.
• If ranked high risk – a reduced list of preventative
strategies was available to choose from –
– Reposition frequently -Pillows for boney areas
– Barrier cream if incontinent -Air mattress/air cushion
• Repositioning could be added as an activity for
moderate risk but most staff didn’t add it.
Lost in translation
Interim measures
• The e-pathway committee had been informed
about some of these issues, it appeared that it was
difficult to make the changes that were required.
• Formation of new pathway screens were designed
specifically by some wards e.g. a screen of
checking boney prominences was created by the
orthopaedic ward.
• Stop Pressure Ulcer day
November 2013
Preventative strategies committee
• Meets quarterly
• Includes reports on falls and pressure injuries
collected from riskman and coded data through
clinical information
• Policy review
• National Standards
• Best practice
• Benchmarking
Benchmarking
• HBN –Hospital Benchmarking Network
– CNA : Catholic Negotiating Alliance
• Activity and Efficiency
• Complaints, Falls and Serious harm
• Infection
• Obstetric
• Staff Harm Exposure
• Readmission
Rate of Serious
Harm (S3 & S4)
per 10,000days
Standard 8
• Governance and systems for the
prevention and management of
pressure injuries.
• Preventing pressure injuries
• Managing pressure injuries
• Communicating with patients
and carers
Standard 8 action required
• Governance – complied
• Preventing – risk assessment; skin
assessment; prevention strategies
needed attention
• Managing – complied
• Communication with carers –
needed attention
Policy Directive action required
• Pressure Injury Risk –
factors influencing
perfusion; skin status
• Risk assessment – Skin
assessment
• Prevention strategies –
additional strategies
required.
Another Catalyst for action
• In March 2014, a QCR (Quality Care Review)
report reviewed a patient who had developed
bilateral stage 3 heel pressure injuries while in
hospital.
– Documentation poor –only option for skin assessment
was intact, reddened or broken. No area for site.
– Braden only flagged preventative strategies for high
risk patients
• Already compiling an updated program based
on best practice
ACTION
• Sub Committee formed June 2014
– Review of Braden Score
• Addition of Risk Factors section
– Reviewed Prevention strategies allocated to low, mod
and high risk patients
– Addition of skin assessment on admission then linked to
prevention strategies based on level of risk
– Addition of carers brochure –Move, Move, Move
– Addition of Falls, Skin, Braden, VTE &Nutritional screen
– Formation of an educational video for staff
So what happened?...........
What’s next?
• Continue to review and improve processes based
on best practice guidelines
• Audit compliance
• Creation of multi focused brochure on falls
prevention, PIP and nutrition for carers and
families
• Quality project