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Irene Lake, Canberra Hospital ACT - Pressure Injury Prevention- Past, PRESENT, Future
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Transcript of Irene Lake, Canberra Hospital ACT - Pressure Injury Prevention- Past, PRESENT, Future
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