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!
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