Pressure Injury Prevention – past, PRESENT, future

ACT Health

• Canberra Hospital - 699+ beds and growing

• Catchment population ACT/NSW = 540,000

• OBD’s = 244,000+ annually

• Community Care = 5 Community Health Centres and home visits

Pressure Injury Prevention

Leadership

Staff engagement

Dedicated resources

Support at Executive/Senior

level

Readiness for improvement

Ownership

People who influence

Process of implementation

Integration into practice

Evidence of improvement

Canberra Hospital & Community Care Pressure Injury Prevalence

31.5

18.7

25.1

18.9

13.5

16.3

10

8.4

9.2

6.3

10.5

8.4

0

5

10

15

20

25

30

35

Canberra Hospital Community Care ACT Health

2002

2004

2006

2008

2009

2010

2011

2012

2013

2014

4.4

1.1

14.6

6.2

8.3

4.1

2.8

0

2

4

6

8

10

12

14

16

18

20

2010 2011 2012 2013 2014

Canberra Hospital Community Care ACT Health

P=<0.001

Hospital Acquired Pressure Injuries 2010- 2014

16 17

8

14

67

15

0

10

20

30

40

50

60

70

80

Canberra Hospital Community Care

Compliance to using alternating air mattress and pressure injury status

Pressure injury & air mattress Pressure injury no air mattress No pressure injury & air mattress

Leadership

Dedicated resources

Support Exec level

• My role

• Link with DON’s

• Director General

• Chief Nurse

• Executive Directors/DON’s

• Senior medical staff

• Tissue Viability Unit

• Nurse Practitioner

• Community CNC

• Equipment

Staff engagement

Ownership

Readiness for improvement

• Early engagement

• Annual prevalence

• Feedback results

• Staff auditing

• Use of current data to

demonstrate need to improve

• Staff recognise need to

improve

• Staff involvement in

PIP

People who influence

Integration into practice

Process of implementation

• CNC & CDN engaged

• DON & ADON

• Experts

• Incremental after each

prevalence

• Guidelines

• Policy/SOP

• TVU – staff rotation

• Electronic data collection

• Centralised equipment

• Baseline mattresses

• Champions

• Standardisation products &

processes

• Education

Evidence of improvements

Data integrity

The Future • What can we change?

• Sustainability

• Education of surveyors

• Refined process for data

collection

• Photographs

• Annual prevalence results

• Significant improvement

Classification of Hospital Acquired Pressure Injuries 2014

0%

10%

20%

30%

40%

50%

60%

70%

80%

Canberra Hospital Community Care

Stage 1 Stage 2 Stage 3 Stage 4 Unstageable DTI

1

5

Skin integrity

Risk assessment

Support surface

Heels offloaded

Turning regime

Protective foam dressing

Skin management

Referral

Patient involvement

14.6

6.2

8.3

4.1 2.8

0

2

4

6

8

10

12

14

16

2010 2011 2012 2013 2014 Hospital acquired pressure injuries

%

- Education modules x 2 per year - Only 2 staff with high level expertise - Missing data on survey tools - Previous attempts at mattress replacement failed - 32 staff involved in PIP - Patients consenting = 78%

- My role commenced - Risk assessment tool & guideline at end of bed - 40 staff involved in PIP - Missing data - Patients consenting = 82%

- Changed on line e-learning - 48 staff involved in PIP - Electronic data collection - Increased staff access to wound modules & other education - Baseline mattress replacement over 12 months commenced end of 2011 - Additional resource to TVU - Clinical guideline updated - Standardising products - Patients consenting =82%

- 64 staff participated in PIP - Centralised equipment - Purchased additional air mattresses - Equipment loan in Community more responsive - Photographed PI found during prevalence -TVU increased to 3 FTE - Clinical review commenced - Patients consenting =80%

- 60 staff participated - Photos of PI's found - Air mattress within 1 hr - Additional CNC for Community -Patients consenting = 90% - New Care Plan

Hospital Acquired Pressure Injury Prevalence 2010 – 2014 – the journey

The Future

Navigating the maze

Prevention is better than cure