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