Update:
Improved Woundcare Program Australia
September 2013
Terri Antonio Consultant
Nursing Practice Solutions Inc.
Session Agenda
• Chronic Disease & Woundcare
• Industry Changes & Challenges
• An Integrated Solution to Wound Management
• Audit, Implementation, Measurement & Reporting
• Progress and Outcomes
• Questions/Discussion
Chronic Disease & Wounds
• The impact of chronic conditions on Australians is considerable
• Where do chronic wounds fit?
– Chronic wounds are associated with co-morbid chronic diseases:
• Pressure injuries (Multiple co-morbidities)
• Diabetic foot ulcers (Diabetes)
• Post surgical infected wounds (Multiple co-morbidities)
• Peripheral vascular disease (Cardiac)
• Leg ulcers (Venous disease)
• Arterial ulcers (Congestive heart, COPD etc)
• Malignant wounds (Cancer)
Industry & Governance Changes
National Safety & Quality Health Services Standards (ACSQHC)
• Standard 8: Preventing & Managing Pressure Injuries
• “Health Service organisations have governance structures and systems in place for the prevention and management of pressure ulcers”
• “An evidence-based wound management system is in place within the health service organisation”
• Full implementation of new standards commenced January 2013
Activity Based Funding for Australian Public Hospitals (IHPA)
• Set weighted activity payment for all procedures
– Adverse quality performance will not be modelled or funded
• e.g. pressure injuries, surgical site infections, catheter-associated infections
– Efficient hospitals will benefit financially
Standard 8: Preventing & Managing Pressure Injuries
Governance and systems for the
prevention and management of pressure injuries
8.1 Developing and implementing policies, procedures and/or protocols that are based on current best
practice guidelines
8.2 Using a risk assessment framework and reporting
systems to identify, investigate and take action to
reduce the frequency and severity of pressure injuries
8.3 Undertaking quality improvement activities to address safety risks and monitor the systems that prevent and manage pressure
injuries
8.4 Providing or facilitating access to equipment and
devices to implement effective prevention strategies
and best practice management plans
Preventing Pressure Injuries
8.5 Identifying risk factors for pressure injuries using an agreed screening tool for all presenting patients within
timeframes set by best practice guidelines
8.6 Conducting a comprehensive skin inspection in timeframes set
by best practice guidelines on patients with a high risk of developing pressure injuries at presentation, regularly as clinically indicated during a patient’s
admission, and before discharge
8.7 Implementing and monitoring pressure injury
prevention plans and reviewing when clinically
indicated
Managing Pressure Injuries
8.8 Implementing best practice management and
ongoing monitoring as clinically indicated
Communicating with Patients and Carers
8.9 Informing patients with a high risk of pressure injury,
and their carers, about the risks, prevention strategies and management of pressure
injuries
8.10 Developing a plan of management in partnership
with patients and carers
Challenges in the Hospital Environment
Human Costs
• Patient safety
• Infections (e.g. MRSA) Economic Costs
• Length of stays
• Lengthy discharge
• Hospital waiting lists
• Funding (e.g. cover for PI’s?)
• Use of finite resources
Program Stages
Independent Audit & Baseline Report
• Tailored report with distribution rates for all wounds
• Staff knowledge needs assessment
• Planning Day with cross-functional representation
Protocol Implementation, Training & Education
• All staff trained to deliver consistent wound care
• Uses adult learning principles & evidence based curriculum
• Train-the-Trainer model
Program Tools, Resources, Measurement & Reporting
• Revised documentation and quality reporting
• Multi-disciplinary committee to manage ongoing
Nurse Sensitive Outcome Measures
Clinical Audit Findings (inpatient data)
Clinical Audit:
• 19 Health Services – Admitted Patient/resident data
• Number of survey participants:
– 2,274
• Survey benchmark
– Demographics
Age Female Diabetic Insulin
Dependent Incontinent Braden LOS
77 years 65% 22% 39% 54% 14 23 months
Clinical Audit Findings
Clinical Audit:
• 19 Health Services – Admitted Patient/resident data
• Number of survey participants:
– 2,274
• Survey benchmark
Nurse Sensitive
Outcomes Pressure Injury Distribution
Daily Dressings
Facility Acquired
PIPP
Heels Coccyx Buttock Foot Ankle
23% 15.7% 39% 17% 15% 12% 8%
Program Resources
• Education Program – Curriculum
– Materials
– Train-the-Trainer
• Wound Care Chart – TIME principles
– Integrated with Education & Formulary
• Integrated Care Pathways
– Pressure Injury Prevention & Management
Education Outcomes
Training Program
• Pre & Post Training Knowledge Assessment (Modules 1-3)
• Combined outcomes from participating Health Services
Knowledge Domain Pre Training Benchmark Post Training Results Improvement
Factors leading to Pressure Injury 94% 98% 2%
Moist wound healing 84% 97% 13%
Interventions for preventing Pressure Injury 80% 95% 15%
Povidone Iodine, indications for use 68% 91% 23%
Contraindications for debridement 66% 92% 26%
Dressing choice 43% 89% 46%
Elements of best practice wound care 38% 90% 52%
Concept of wound contamination 35% 90% 55%
Managing bacteria in the wound 38% 99% 61%
TIME principles 7% 100% 93%
Outcomes: 3 months
Wimmera Health Care Group (WHCG)
• 43 trainers:
– Continuing monthly education sessions to capture staff missed in the initial training
• Classroom & ward level
– Conducting audits on PI prevalence,
documentation of wound charts, risk screens, prevention plans
• Audit tools on survey monkey – instant data accessible
• Monthly calendar established with monthly
“themes” in relation to PI prevention and wound management
• Equipment audits conducted: gap analysis, mattress audits – to strategically plan for new equipment
WHCG Priority Ward
PIPP decreased by 28% in 3 months
Outcomes: 12-18 months
Facility Acquired Pressure Injury Point Prevalence:
Reductions in PIPPS for services 12-18 months post implementation
Benalla Health -73%
Goulburn Valley Health -14%
Northeast Health Wangaratta -20%
Ballarat Health Services -45%
Outcomes: 12-18 months
Severity of Injury:
Reductions in severity of Pressure Injury 12-18 months post implementation
Benalla Health -47%
Goulburn Valley Health -58%
Northeast Health Wangaratta -58%
Outcomes: 12-18 months
Frequency of dressing changes:
Reduction in the number of wounds dressed daily 12-18 months post implementation
Benalla Health -50%
Goulburn Valley Health -40%
Northeast Health Wangaratta -65%
Ballarat Health Services -88%
Outcomes: 3 Years
Ballarat Health Services Pressure Injury Point Prevalence:
Acute SubAcute Residential Total
11% 26% 9% 11%
9% 11% 5% 6%
2.5% 8% 3% 3.7%
Outcomes
3 Months:
• Improved awareness, knowledge, focus, systems and monitoring
1 Year:
• Reduced facility acquired Pressure Injury Point Prevalence
• Reduced Severity of Pressure Injury
• Reduced Frequency of Dressing Change
3 Years:Sustained improvements across all nurse sensitive outcomes
BHS: Operational – Program Outcome
Ballarat Health Services
Acute Separations
Pressure Injury Point
Prevalence
Estimated Additional
Bed Days
Estimated Bed Day Savings (cumulative)
2009
Benchmark 33,607 11% 13,456 Nil
2011 34,909 9% 11,436 2,020
2012 36,531 2.5% 3,324 10,132
Looking to the Future
Self Management Program
The integration of client self-management and empowerment into the wound care program helps to place the client at the center of care
decisions and support development of a true client-centered care delivery model.
Incorporating:
• Education to promote self-management
• Client health record ‘health passport’
• Timely follow-up with primary/specialty care
• A list of ‘red flags’ indicative of worsening condition and how to respond
QUESTIONS?
Terri Antonio
Consultant Nursing Practice Solutions Inc.
Phone: 0478 789 114
Email: [email protected]
