maree connolly - nsw clinical excellence commission - change management and engaging clinicians in...

Pressure Injury Prevention Project

Clinical Excellence Commission Maree Connolly

September 2015

Change Management and Engaging Clinicians in NSW in

Pressure Injury Prevention

“It may be a strange principle to enunciate as the first requirement in a hospital that it should do the sick no harm.” Florence Nightingale, 1863

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Guidelines

Pan Pacific Clinical Practice Guidelines for the Prevention and Management of Pressure Injury 2012

Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline 2014

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The Australian Commission on Safety and Quality in Health Care (ACSQHC) has recognised pressure injuries as the fifth most costly and commonly occurring preventable condition

Jackson T, et al. Marginal costs of hospital-acquired conditions: information for priority-setting for patient safety

programmes and research. Journal of Health Services Research and Policy. Vol 16 No 3 July 2011

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Pressure Injury Prevention in NSW aligned with:

Prevention and Treatment of Pressure Ulcers: Clinical

Practice Guideline

NSQHSS - Standard 8 Preventing and Managing

Pressure Injuries

Pressure Injury Prevention and Management Policy

NSW Health

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NSW Health • NSW population - over 7.5 million, with over 4.8

million living in the Sydney metropolitan area

• The population is growing and it is also ageing • NSW Health is the biggest public health system in

Australia

• More than 220 public hospitals

• Approximately 105,000 dedicated staff (FTE) make up the health workforce

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NSW Health On a typical week day in NSW: • 17,000 people spend the night in a public hospital

• 6,500 people are seen in EDs

• 5,600 people are admitted to a public hospital

• 1,000 patients have their surgery (emergency or planned)

performed in our public hospitals

All figures on this page are based on the 2013-2014 financial year.

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NSW Health: HIE ICD-10 coded data

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0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2011

2012

2013

0

2,000

4,000

6,000

8,000

10,000

2011 2012 2013

PI

Cas

es

Pressure Injury Cases in NSW

Condition not noted on admission

Condition noted on admission

Not reported

Clinical Excellence Commission

The Clinical Excellence Commission (CEC)

is responsible for leading safety and quality

improvement in the NSW public health system

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2011

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CEC programs ? 2015

Working together to promote pressure injury prevention in NSW

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CEC website http://www.cec.health.nsw.gov.au/programs/pressure-injury-prevention-project

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Policy Implementation Guide

• Facility implementation plan

• Action plan

• Risk assessment requirements

• Prevention strategies

• Prevention and management flowcharts

• Education for staff, patients, family and carers

• Monitoring and auditing framework

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Pressure Injury Prevention and Management Flowcharts

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eLearning Modules

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eLearning Module

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Monitoring & Auditing Framework

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Monitoring & Auditing Framework

Recommendations:

1. Conduct a point prevalence survey at least annually

- number of patients with PI at a specific time point

- concurrent audit of compliance with core aspects of preventive care

2. Conduct a best practice clinical audit of care process documentation

- collect regularly (frequency decided locally).

3.Regular monitoring of recorded PI incidence in each organisation using routinely collected data

- occurrence of new cases in an organisation

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Quality Audit Reporting System (QARS)

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Electronic Medical Record (eMR)

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Quality System Assessment (QSA) 2014

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Quality System Assessment (QSA) 2014

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New resource: Lanyard

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New Resource: Classification reference card

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Speciality groups: Paediatric

• Working with NSW Kids and Families

• Engagement with state wide CNC group

• Resource development

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Guideline - special populations

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Paediatric individuals

• Age appropriate risk assessment - Adapted Glamorgan or Braden Q

• Skin assessment

• Children with medical devices considered at risk • Inspect the skin around and under medical devices

at least twice a day

• Engage with family/carer involvement in care planning and care

• Regularly assess nutritional requirements • Engage caregivers to promote nutritional intake

• Select age appropriate, high specification support surface for children at high risk

• Repositioning is an important strategy • Frequent repositioning of the head of neonates and

infants when sedated and ventilated

Speciality groups: Paediatric

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Speciality groups: Spinal cord injury

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Speciality groups: Spinal cord injury

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Speciality groups: Critically ill Adults

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Speciality groups: Critically ill Adults

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Speciality groups: Community

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Specialty groups: ED

• 6,500 people are seen in EDs in NSW daily

Orange Health Service

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Specialty groups: ED

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Example of APAM usage

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SURGICAL 22%

MEDICAL 16%

REHAB 12%

CCU 10%

ICU 18%

ED 13%

OT 0%

PAEDS 0%

EDSU 0% MATERNITY

0%

POOL 9%

Monthly Mattress Bed Days – April 2015

SURGICAL

MEDICAL

REHAB

CCU

ICU

ED

OT

PAEDS

EDSU

MATERNITY

POOL

Monthly Mattress Bed Days

SURGICAL 262 8.73

MEDICAL 198 6.60

REHAB 138 4.60

CCU 124 4.13

ICU 216 7.20

ED 155 5.17

OT 0 0.00

PAEDS 0 0.00

EDSU 1 0.03

MATERNITY 0 0.00

POOL 106 3.53

Jake’s story - why we need to change

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Jake’s Story: Pressure Injury Impact • Bed rest for many months • High risk of sepsis • Complicated renal failure • Weight loss • High risk of autonomic dysreflexia • Mental health impact (social isolation) • Loss of confidence in the health system • Zero fun factor • Interruption to rehab and work • Reduced independence • Financial strain

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Jake’s Story: Points for consideration

Length of time spent on surfaces exerting high amounts of pressure caused adverse events with major consequences

Jake’s story highlights the need for timely pressure care which must include early assessment and intervention in ED

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Patient based care model

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Patient focus

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“Pressure sores could be prevented by good nursing care” Florence Nightingale 1861

Patient Information Brochure

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Patient Information Brochure

• There was consumer input in the development of the brochure

• The brochure can be printed from the CEC Pressure Injury Prevention Project webpage

• Available in nine languages: English, Arabic, Greek, Traditional Chinese, Simplified Chinese, Hindi, Vietnamese, Korean and Italian

• The English version of the patient information brochure is available to order through Stream Solutions Order Number NH606696 Cost pk50 $33.42+GST

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Patient focus

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Patient focus

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Patient focus

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Critical success factors for improvement

• Timely identification of patients who are at risk’

• Timely reassessment if a change in condition/location

• Good communication between the patient/family/carer and the care team

• Individualised care plans based on needs

• Implementation of prevention strategies

• Measurement and timely feedback to clinical staff

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Questions

Maree Connolly - Project Officer, Pressure Injury Prevention Project Maree.connolly@cec.health.nsw.gov.au

Thank you

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For further information:

Maree Connolly

Maree.connolly@cec.health.nsw.gov.au

Or Pressureinjury@cec.health.nsw.gov.au

www.cec.health.nsw.gov.au