linda jongeling & wendy pankhurst - mckenzie aged care group - mckenzie aged care pressure group...

Pressure Injury Project: Applying the Standards in Aged Care

Presented by :

Wendy Pankhurst, Quality Systems Coordinator / Group Support

Linda Jongeling, Group Professional Development Manager

McKenzie Aged Care Group

We are an Australian family company; the family

directors work within the business every day, playing

an active role in the operations and development of all

current and future McKenzie residences.

Our Mission:

We are committed to enriching the lives of people by providing

care with compassion, respect and integrity to promote the

health, independence and social interaction of seniors.

Our Locations:

We have 15 facilities in Victoria, NSW and Queensland and

2 retirement communities in Queensland.

Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group

Our Facilities

3 Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group

Background:

Why was a Pressure Injury Project

implemented at MACG?

The number of pressure injuries reported were

increasing;

We were aware that treatment of PIs was costly; and

Most importantly PIs were preventable, so we needed

to take this seriously.

In addition to this there has been an increase in

litigation.

In March 2013 we conducted a review of Pressure

Injuries across the MACG group.


In March 2013 we conducted a review of

Pressure Injuries across the MACG Group

Findings of the review:

High number of pressure injuries across the

group in the 6 months prior to March 2013.

The most prevalent location of pressure injuries

over the last 6 months were buttocks – 60%.

The next most prevalent are heel injuries – 16%.

The most prevalent stage of pressure injury

across the group is Stage 1;

50% of pressure injuries identified are Stage 1

43% of pressure injuries were Stage 2


An Opportunity for Improvement

The review identified that:

• We had an unacceptable number of

pressure injuries.

• We had a real opportunity to make

significant improvement through

implementing sustainable preventative

strategies for our residents at risk of

pressure injury.


Pressure Injury Project Plan

Project Goal

• Reduce facility Acquired PIs across MACG and develop a Zero

tolerance to future pressure injuries.

Key Outcomes:

• A reduction in facility acquired pressure injuries across MACG

(50% in 6 months).

• Ensure appropriate pressure relieving equipment and

mattresses are in place or purchased.

• Clinical staff will have improved knowledge of PI prevention.

• Early recognition and treatment of PI.

• Improved monitoring and reporting of PI across MACG.

• Improved resident satisfaction with clinical care.

(Measured by 2015 Press Ganey Survey).


Implementation of the Project

Organisational Support:

• Organisational and board level support is very

important for a project of this type. We were really

fortunate to have the support to allow us to

proceed with this project.

• When you need to look at equipment and training

across the organisation you will certainly need this

support to make it a success


Implementation: Establish a Committee

We established an organisational pressure injury

steering committee:

• Monthly Meetings – committee comprised of a number of

representatives including facility managers from each

facility across the group, regional management and

professional development manager, operational

management.

• This was pivotal in getting buy-in from the homes and

ensuring that the expectations were clear to establish a

zero pressure injury approach.

• It was also important to have transparency of the results

in each facility and the number of incidents each month,

either from hospital or facility acquired.


We partnered with EBOS and Novis to attend

pressure equipment audits.

We involved and educated our own staff for each

audit on what to look for so that we could sustain this

review in the future.

They attended a 100% audit of our equipment all

beds, mattresses and chairs including princess type

chairs for all of our residents across all of our homes.


Implementation: Equipment Requirements

We assessed every resident to prioritise equipment

required - based on clinical need, risk assessment,

and ability to reposition.

We did this with the clinical teams at each home,

this took a couple of weeks to attend all 8 homes. It

was very time consuming but essential part of the

project.

This enabled us to determine what equipment

required replacement urgently, in next 6 months or

in the next year.


Implementation: Equipment Requirements

We needed to replace equipment – this was a huge

undertaking but was worth the investment.

We determined product group across the group;

mattresses, air alternating mattresses, etc.

We implemented a labelling system and register of all

equipment.

We commenced regular auditing of air alternating

mattress equipment.


What we did as a result of the audit:

Monitoring and Reporting

We introduced:

• An amended incident form that had clearer definitions of pressure

injury stages as per the national pressure injury guidelines.

• We developed a pressure injury management checklist and

commenced a system whereby we required each new pressure

injury to have a pressure injury management checklist completed.

• We set up alerts in our incident management system for each

pressure injury so that dedicated people, eg General Operations

Manager and Group Quality System Manager and Regional

Operations Managers were alerted to pressure injury occurrence.

• This was an important step in changing the culture and setting

expectations for a shift in mindset to preventative rather than

reactive management. It was the change that ensured that pressure

injury was taken seriously.


Pressure Injury Management Checklist

The reason for introducing the pressure injury management

checklists was to ensure that:

• risk assessment reoccurred;

• monitoring of the equipment in place for the type of pressure injury;

• an opportunity to look at staff practices and knowledge eg can the

resident reposition when seated by themselves, how long did the

resident sit for and what type of chair; and

• checklist also looked at nutrition, continence, pain, education for the

resident, wound care and practices for prevention and treatment.

• In the initial stages of the use of the document, it actually identified a

knowledge gap. So was useful in guiding a change in practice.


Education Requirements

We developed an education package based on the

knowledge gaps we had been identifying which appeared

systemic.

A pre test of staff knowledge was completed which

identified gaps.

We sourced an external trainer to deliver to all nursing

staff across all our homes. It was a mandatory component

– once again emphasising the organisational commitment

to this preventable injury.

We completed a Post staff to measure improvement in

staff knowledge.


We also developed “prevention and early detection

is critical” cards;

Laminated cards for each staff member to attach for

reference to each ID – stage 1 and 2.

Second side, card – who is at risk of pressure injury

and tips on how to relief pressure practically.

This was a great initiative as a quick reference for

staff caring for our residents on the floor.

Our reporting of stage 2s has now decreased. Early

identification is improving.


Education Requirements

Pressure Injury - Staff Lanyard Cards


Education Requirements:

We identified that we needed to establish key people in the

facility and provide them with a higher level of specialised

training.

We sourced Tracy Norwicki to provide one day training for

these people from each of the facilities across the group. We

held a one day conference in Victoria and on the Gold Coast.

Now we also had passionate people that were excited with

what they could achieve right across the group. Tracy also

assisted us through her great presentations with the clear

message that Pressure injuries are preventable and not

acceptable.

This training was a great turning point for us. She certainly

shares our passion with pressure injury prevention.


PI Posters

Our Learnings:

Pressure Injury prevention requires a behaviour

change.

We need to be proactive rather than reactive –

residents are entering residential care with much

higher care needs. Along with this is the introduction

of the consumer directed care and living longer living

better reforms. We have now moved to a preventative

model now in most of our homes.

Pan Pacific guidelines are our bible.

You cant take your finger off the pulse for one second.

We are always spinning many plates.


We found that there were delays in equipment and

assessment for new residents and for residents with

changes in care requirements.

As a result we have reduced the timeframes for

assessing residents on admission and return from

hospital. This has been a noted improvement as also

inclusive on checklists regarding the expectation.

We have introduced checkpoints to identify when

residents decline and pressure care requirements

change through our clinical governance.


Our Learnings:

We have reviewed our assessment tools and added

prompts to guide best practice pressure care

• looking at use of bed cradles, the way sheets are tucked in,

• reviewing seating times, cap to 2 hours in princess chairs where

possible,

• return to bed for a rest particularly (with individual needs considered).

Our care plans are more individualised around pressure

injury prevention and management– previously there was

limited information in our care plans except 2/24

repositioning included as a common phrase and not

much else.

We have a lot more information in place now to guide the

care required.


Our Learnings:

Our Successes:

Improvement in Staff knowledge

Culture of prevention

6/7 facilities have had zero facility acquired PIs

Shift from Stage 2 PIs to Stage 1 PIs

PI Committee now includes Dietician, Physio and

Podiatrist

Adequate equipment in place across the group with a

standardised list.


Celebrating the successes:

Reward system – each facility that achieves a zero PIs

is recognised and rewarded - through posters,

chocolates, gift cards.

The entire McKenzie staff group is notified by email of

the success.

The MACG Sharepoint / intranet system front page is

also updated so when logging in it is the first notice

staff read.

As a result there is now healthy competition between

facilities in regard to achieving zero pressure injuries.


What is next?

Review Pressure Injury Committees at facility level,

looking at the idea of rounding.

Further Education – repositioning, involve physio here,

to reduce sheer forces, re-education of manual

handling trainers. Also developing an e-learning

module for new staff.

New equipment – currently looking at a new air

mattress that self adjusts to the weight of the person

and can be used for 0kg to 200kg.


MACG Pressure Injury Project

We have made significant inroads into creating a culture of

zero tolerance to pressure injuries and we will continue to keep

the staff engaged to keep the pressure off.

Contacts:

Amanda Seymour, Group Quality System Manager

[email protected]

Wendy Pankhurst, Quality System Coordinator/Group support

[email protected]

Linda Jongeling, Group Professional Development Manager

[email protected]

www.mckenzieacg.com


mailto:[email protected]



linda jongeling & wendy pankhurst - mckenzie aged care group - mckenzie aged care pressure group...

Health & Medicine