Prevalence of pressure ulcers in community: Room for ... · geographical area of over 130,000 square kilometres - the size of England. ... Data collection 4-week period was commenced

Prevalence of pressure ulcers in community: Room for improvement Margo Asimus Nurse Practitioner-Wound Management Greater Newcastle Cluster

Iris Li 2009 PUPP Project OfficerNursing & Midwifery ServicesLiving with Equipment Brisbane Aug 2011

Where is Hunter New England HealthHNE Health provides care for approximately 840,000 people and covers a geographical area of over 130,000 square kilometres - the size of England.

2

Pressure Ulcer Prevention Project

• History & Project approval• 2008 Project Plan – Crystal Model• Annual Point Prevalence Study:

– inpatients & community clients• Community key focus areas implementation

3

Crystal Model: A crystal clear solution

Community

4

Methodology

Setting •Community health centres of the eight clusters in Hunter New England HealthSample•A random sample of 800 clients in all the community health centresInclusion and exclusion criteria•All consenting community nursing clients will be included in the study.

5

Map of HNE Health

6

Ethics consideration

• The prevalence survey was approved by the Hunter New England Human Research Ethics Committee. All participants were fully informed of the survey requirements before verbal consent was requested.

7

Methodology

Surveyor Training•Community Nurses completed surveyor training •Online Pressure Ulcer Education Package •Achieve at least 90% in online assessment test•Orientate the nurses to the study and survey tool

8

Data collection

4-week period was commenced in October 2009 & repeated in Nov 2010. This consisted of 3 parts:

1. Patient risk assessment and skin inspection by the primary community nurse surveyors; 2. Verification of the pressure ulcer severity by a nurse practitioner in wound management by reviewing all digital images uploaded into community nurse electronic database 3. Audit of all electronic documentation by project team

9

Key findings

Sources of pressure ulcers (in number of clients)

11

2009

Total number of clients acquired PU during community nursing

care=21

Total number of clients presented with hospital-

acquired PU=14

Total number of clients presented with PU prior to community nursing

care=17

(4) (1)

2010

Risk level assessed by surveyors

12

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%

2002 2003 2004 2009 2010

SilverChainHNELHDGNC

Severity of pressure ulcers

12.1%

9.0%

20.7%

40.5%

29.7%

42.4%

34.8%

10.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

Stage 1 Stage 2 Stage 3 Stage 4

2009

2010

13

Equipment waiting time for clients with PU

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

No Device Unsure Within 1week

Longer than1 week

NA (Self-purchased)

20092010

Pressure Mapping of Sacrum

• Lying Supine• ED trolley with standard mattress b) ED trolley with Repose mattress on top of standard

mattress

Pressure Mapping of Sacrum

• Supine with 35 degrees of head elevationa) ED trolley with standard mattress b) ED trolley with Repose mattress on top of standard mattress

Pressure Mapping of Sacrum

• Supine with 55 degrees of head elevationa) ED trolley with standard mattress b) ED trolley with Repose mattress on top of standard mattress

Pressure Mapping of Sacrum

• Supine with 75 degrees of head elevation

a) ED trolley with standard mattress b) ED trolley with Repose mattress on top of standard

Pressure Mapping of Heels

• Lying supine

a) ED trolley with standard mattress b) ED trolley with Repose mattress on top of standard

Repose in the community

Patient transport study: A 360° change

• In the beginning of the pilot studySome nurses said," I don’t think pressure ulcer is a

problem here”“The survey form and patient skin inspection are a

pain, extra work”• 2 months later“I couldn’t let my patient to go the Control Group! It’s

the duty of care!”“I know that patient was ineligible, but I have done the

survey form to show how effective and comfortable the mattress was”

Key outcomes

• PU Prevalence study completed within existing resources.

• 3 PU source classifications have been developed.

• Key improvement strategies implemented following this study:– Obtain PU risk score from patient referring agents– Developed electronic flagging system to alert clinicians which

client is at very high risk or with a pre-existing PU – Improve the availability and accessibility of equipment by

introducing light-weight pressure redistributing equipment– Staff education

22

Our Publication

• Asimus M & Li I. Pressure ulcers in home care settings: is it overlooked? Wound Practice and Research 2011; 19 (2): 88-97.

• Asimus M, Maclellan L & Li P. Pressure ulcer prevention in Australia: the role of the nurse practitioner in changing practice and saving lives. International Wound Journal 2011; 8 (5): 508-513.

23

Reference

• Paquay L, Wouters R, Defloor T, Buntinx F, Debaillie R, Geys L. Adherence to pressure ulcer prevention guidelines in home care: a survey of current practice. Journal of Clinical Nursing. 2008; 17: 627-36.

• Ferrell B, Josephson K, Norvid P, Alcorn H. Pressure ulcers among patients admitted to home care. J Am Geriatr Soc. 2000; 48: 1042-47.

• Lewin G, Carville K, Newall N, Phillipson M, Smith J, Prentice J. Skin safe. Implementing clinical guidelines to prevent pressure ulcers in home care clients. Primary Intention. 2007; 15: 4-12.

24

Australian Wound Management Association (AWMA)

Go to the Elephant in the Room website for the latest Wound Awareness Week informationwww.elephantintheroom.com.au

2012 AWMA Conference Sydney Convention & Exhibition Centre 18 -22 March 2012 www.awma2012.com

25

http://www.elephantintheroom.com.au/campaign