Preventing Pressure Injuries in Children

AAAdapted Glamorgan Risk Assessment Tool Case Study

CLINICAL EXCELLENCE COMMISSION

Revised: November 2017

Developed by

NSW Paediatric Pressure Injury

Resources Working Group

Patient safety outcomes

• Patient outcomes – pressure injury incidents

– ongoing injuries from pressure injuries

– knowledge about pressure injury prevention

• Program outcomes – Interdisciplinary approach to pressure injury

prevention and management – clinician awareness of pressure injury prevention

and management – Use of standardised pressure injury risk assessment

tools and resources – Assistance with meeting National Standard 8

2

Preventing & Managing Pressure Injuries

Evidence indicates the most effective approaches to pressure injury prevention & management include:

• Timely risk assessment to identify risk factors

• Use of a validated risk assessment tool to guide clinical decision making to identify pressure injury risk

• The engagement of patients and/or their carers with clinicians

• Implementation of individualised care plans

• Monitor and analyse pressure injury data, and to implement relevant quality improvement activities.

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4

Care actions – at risk

Risk score Risk category Suggested action

Mobility (M) 10

At risk

Inspect skin at least twice a day. Relieve pressure by helping child to move at least every 2 hours. Use an age and weight appropriate pressure redistribution surface for sitting on/ sleeping on.

5

Care actions – high risk

Risk score Risk category Suggested action

Mobility (M) 15

High risk

Inspect skin with each positioning. Reposition child at least every 2 hours. Relieve pressure before any skin redness develops. Use an age and weight appropriate pressure redistribution surface for sitting on/ sleeping on.

6

Care actions – very high risk

Risk score Risk category Suggested action

Mobility (M) 20

Very high risk

Inspect skin at least hourly. Move or turn if possible, before skin becomes red. Use an age and weight appropriate pressure redistribution surface for sitting on/ sleeping on Consider using specialised pressure relieving equipment.

7

Care actions – devices

8

Risk score Risk category Suggested action

Devices

(D) 10

At risk

Reposition equipment/ devices at least every 2 hours. Ensure equipment / objects are not pressing on the skin.

Case study Day 1

Max is a 8 year old boy who has been in hospital for several days. Max has multi-level spinal injuries following an MVA nursed in a body brace and on 3-4 hourly pressure area care involving team log rolls.

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Case study Day 1 Mobility Total score: 21 Devices Total score: 10

10

10

21

Case study Care actions/interventions • VERY HIGH RISK

• Nursed on back because cervical spine has not been cleared.

• Strict regime for pressure area care 3-4 hourly and on spinal precautions.

• Pressure injury risk noted on routine cares.

• Prophylactic dressing applied for protection.

• Repeat pressure injury assessment daily.

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Case study Day 8

Max has his brace removed for a skin assessment on day 5.

When removed there was significant ooze and offensive odour from the occipital region of the head. After the area was cleaned by nursing staff a haemoserous fluid was noted on the wipes.

Area was assessed by nursing staff, medical officer was present for the roll alerted to the pressure injury.

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Case study Day 8 Mobility Total score: 21 Devices Total score: 10

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10

21

Case study Care actions/interventions • VERY HIGH RISK

• No further padding (as orthotics stated the brace had enough padding), instead a new brace was altered to account for the pressure injury.

• Continue strict regime for PAC 3-4 hourly and on spinal precautions.

• Continue noting pressure injury on routine cares.

• Treat pressure injury as per local guidelines in consultation with CNC.

• Repeat pressure injury assessment daily.

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Day 1 Day 8

10

21 21

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Local Health District Pressure Injury Steering Committee Representative

OR

Local Health District Children’s Healthcare Network Paediatric CNC

OR

Clinical Excellence Commission

Who do I ask for more information?

Acknowledgements

NSW Paediatric Pressure Injury Resources Working Group

Sydney Children’s Hospital Network

John Hunter Children’s Hospital

NSW/ACT Paediatric and Children’s Healthcare Network CNCs Group

NSW Kids and Families

Clinical Excellence Commission

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Thank you

For further information:

CEC-pressureinjury@health.nsw.gov.au

CEC-PQP@health.nsw.gov.au

www.cec.health.nsw.gov.au