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 of pressure injury prevention plans based

on risk assessment

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, 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.

Point Prevalence (time-series) - Alfred Health

30.7

26.8

20.3

16.217.0 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

Pre

va

len

ce (

%)

Data including pressure injuries present on admission and hospital acquired

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

Po

int

Pre

va

len

ce

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

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.

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

Performance Indicator

• Monitor documentation of pressure injury

prevention plans through quarterly audits

• Future PUPPS results

Baseline Data

• Previous PUPPS results

• 2W PIP Audit Results

‘Appropriate plan identified’:

Feb 2009 – 50%

June 2009 – 40%

October 2009 – 20%

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 2011 2012 2013

Year

Po

int

Pre

va

len

ce

Considerations for the future

• A weekly summary sheet was developed following

several trials.

• The tool is recommended for tracking weekly data.

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

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

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

Pre

va

len

ce

(%

)

2010

2011

2012

2013

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

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

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

Skin Assessment

• Skin Assessment

• Daily or once per shift

depending on Braden

• Within 8 hours of

admission

Braden Risk Assessment

Pressure Injury Prevention PlanMandatory for all patients

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

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!