Date post: | 13-Apr-2017 |
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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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care 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
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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 : Applying the Standards in Aged Care | McKenzie Aged Care Group
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).
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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 Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
Education Requirements
Pressure Injury - Staff Lanyard Cards
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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.
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group
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
Wendy Pankhurst, Quality System Coordinator/Group support
Linda Jongeling, Group Professional Development Manager
www.mckenzieacg.com
Pressure Injury Project : Applying the Standards in Aged Care | McKenzie Aged Care Group