Pressure Injury Prevention Project

Clinical Excellence Commission Maree Connolly

September 2014

A collaborative approach to pressure injury prevention in NSW

Acknowledgement of Country

I would like to acknowledge the traditional custodians of the land on which we meet today, the Kulin Nation. I pay my respect to Elders past and present and to all Aboriginal and Torres Strait Islander people who are here today.

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Key drivers “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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Key drivers - 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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Key Drivers

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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Key Drivers: National Safety & Quality Health Service Standards (NSQHSS)

NSQHSS were introduced nationally on 1 January 2013

Standard 8: Preventing & Managing Pressure Injuries The intention of the Standard is to prevent patients from developing pressure injuries and effectively managing pressure injuries when they do occur.

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NSW Health

• NSW population - 7.3 million, with 4.6 million living in the Sydney metropolitan area

• NSW Health is the biggest public health

system in Australia

• 220 public hospitals

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

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NSW Health

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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 2012-2013 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

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2,000

4,000

6,000

8,000

10,000

2011 2012 2013

PI C

ases

Pressure Injury Cases in NSW

Condition not noted on admission

Condition noted on admission

Not reported

Cost to the Health System

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Clinical Excellence Commission

The Clinical Excellence Commission

is responsible for leading safety and quality

improvement in the NSW public health system

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Steps to Excellence ? 2015 ?!?

Collaborative Approach

Steering Committee A steering committee was established in January 2013 with representation from each LHD/SHN to progress work on pressure injury prevention

The steering committee is chaired by the Chief Nursing and Midwifery Officer Susan Pearce

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Collaborative Approach: Key partners

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Patients,

families &

carers

Collaborative Approach: Resource development

Policy Education eLearning modules

Monitoring and

Auditing Framework

Equipment Patient

information

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Collaborative Approach

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

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Resource Development: Policy

Revised Pressure Injury Prevention and Management policy PD2014_007 was released on 24 March 2014

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Resource Development: 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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Resource Development: Pressure Injury Prevention and Management Flowcharts

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Resource Development: eLearning Modules

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Resource Development: eLearning Module

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Resource Development: Monitoring & Auditing Framework

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Resource Development: Monitoring & Auditing Framework Point Prevalence Survey Documentation pack

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Resource Development: 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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Resource Development: Patient Information Brochure

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Resource Development: 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 Fuji Zerox Order Number NH606696 Cost pk50 $33.42+GST

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Resource Development

Agency for Clinical Innovation

Model of Care for Prevention and Integrated Management of Pressure Injuries in People with Spinal Cord Injury and Spina Bifida, http://www.aci.health.nsw.gov.au/models-of-care/scis-pressure-injury-moc

Guideline: Pressure Injury Prevention for Critically ill Adults available on IC-Wiki - an initiative of NSW Intensive Care Coordination and Monitoring Unit and part of NSW Agency for Clinical Innovation http://intensivecare.hsnet.nsw.gov.au/icwiki/index.php/Welcome_to_ICWiki

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Resource Development: Work in progress

Quality System Assessment (QSA) 2014

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Resource Development: Work in progress

New Information Management System

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Resource Development: Work in progress

Electronic Medical Record (eMR)

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Resource Development: Work in progress

Quality Audit Reporting System (QARS)

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Resource Development: Work in progress

Paediatric resources

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Patient focus

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Patient focus

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

Patient focus Many pressure injuries are preventable and it is recognised that their lengthy healing time has consequences for quality of life, including:

• Susceptibility to infection

• Pain

• Sleep and mood disturbance

Also:

• Impact on rehabilitation

• Mobility

• Long term quality of life

• Death

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Patient focus

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Next Steps: Data and Patient Stories

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Jake’s story - why we need to change

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Jake’s story

Pressure damage resulted in 3 pressure wounds • left iliac crest • left greater trochanter • left ilium (right shoulder

pain prevented repositioning)

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: Organisational impact • Reputation

• Patient safety risk

• Cost of care

• Increased services

• Future litigation risk

• Long durations of On Stretcher Time (OST) adversely effects patients

The damage has been done and it is too late to rescue the ischaemic injury unrelieved pressure caused.

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Jake’s Story: Points for consideration

Pressure mapping indicates greater pressures are exerted over the sacrum when the head of the trolley is raised, regardless of the type of mattress in situ. Consider lying patient flat if not contraindicated from a medical point of view.

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Jake’s Story: Points for Consideration

Pressure Mapping of Sacrum Supine with 75 degrees of head elevation a) Trolley with standard mattress b) Trolley with Repose mattress on top of standard

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Jake’s Story: Points for consideration

Length of time spent on surfaces exerting high amounts of pressure cause 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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DO NO HARM, KEEP OUR PATIENTS SAFE

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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