Standard 5: Comprehensive Care

Preventing and managing pressure injuries

Action 5.21

The health service organisation providing services to patients at risk of pressure injuries has systems for pressure injury prevention and wound management that are consistent with best-practice guidelines

Intent

Evidence-based guidelines are used for prevention and care for patients at risk of or with a pressure injury.

Reflective questions

How are decision-making and management processes described for preventing pressure injuries and for wound management?

What processes are in place to ensure that evidence-based documents and tools for preventing pressure injuries and wound management are current and consistent with best-practice guidelines?

How does the health service organisation ensure that the workforce is following best-practice guidelines and tools for the prevention of pressure injuries?

Key tasks

  • Use information from screening and assessment processes to prevent and manage pressure injuries.

  • Develop or adapt a wound management system that is based on best-practice guidelines.

  • Identify individuals or groups with responsibility for overseeing this system.

Strategies for improvement

Hospitals

Use the screening processes in Action 5.10 to identify patients at risk of pressure injuries and plan for comprehensive care. Use Action 5.12 to ensure that the risk factors and a decision about the need for comprehensive and ongoing skin inspections are documented. Ensure that processes for preventing pressure injuries are based on best-practice guidelines and that details of prevention strategies are communicated to the team caring for at-risk patients.

Prevention and Treatment of Pressure Ulcers: Clinical practice guideline1 is the relevant best-practice guidelines. These guidelines outline the components of, and techniques for, comprehensive skin and tissue inspections.

Implement a comprehensive wound management system that describes the protocols and processes for patient care when a patient’s pressure injury has been identified. Include the assessment, treatment, monitoring and documentation of pressure injuries.

Ensure that assessment of pressure injuries incorporates:

  • The use of a validated risk assessment tool
  • The use of a pressure injury classification system
  • Assessment of pain using validated self-reporting tools such as verbal descriptor, visual analogue or numerical scales
  • Ongoing assessment that evaluates the effectiveness of the wound management plan.

Ensure that treatment addresses:

  • Pain management
  • Wound management
  • Adjunctive treatment options such as heel elevation, prophylactic dressings or electrotherapy
  • Referral to allied health services when indicated, including dietetics or occupational therapy.

Conduct ongoing assessments of pressure injury risks and pressure injury healing, and documentation of all management plans, treatments and interventions provided.

Day Procedure Services

For many day procedure services, pressure injuries may not be a major area of patient harm. However, pressure injuries can happen to older patients, or patients of any age who have one or more of the following risk factors: immobility, lack of sensory perception, poor nutrition or hydration, excess moisture or dryness, poor skin integrity, reduced blood flow, limited alertness, or muscle spasms. Even treatments of short duration may cause or contribute to a pressure injury.

Evidence-based strategies to prevent pressure injuries exist and should be applied if screening identifies patients that are at risk, procedures or recovery take an extended time, or there have been incidents of pressure injuries in the service in the past 12 months.

Screening processes (see Action 5.10) should identify those patients at risk. Monitoring of pressure injuries will allow day procedure services to understand the risks and causal factors leading to pressure injuries, thus allowing prevention and harm minimisation strategies to be implemented.

Examples of evidence

Select only examples currently in use:

  • Data on pressure injuries from the previous 12 months
  • Pre-admission screening documents addressing pressure injury risk
  • Policy documents about preventing and managing pressure injuries that are consistent with best-practice guidelines
  • Training documents about managing pressure injuries
  • Committee and meeting records regarding responsibilities for overseeing the wound management system
  • Reports from clinical data systems that capture progress or outcomes relating to pressure injury wounds
  • Audit results of healthcare records for compliance with policies, procedures or protocols on management of pressure injuries and wounds
  • Feedback provided to the workforce about the results of audits, and actions to deal with issues identified
  • Observation of best-practice guidelines that are used by the clinical workforce.
MPS & Small Hospitals

Use the screening processes in Action 5.10 to identify patients at risk of pressure injuries and plan for comprehensive care. Use Action 5.12 to ensure that the risk factors and a decision about the need for comprehensive and ongoing skin inspections are documented. Ensure that processes for preventing pressure injuries are based on best-practice guidelines and that details of prevention strategies are communicated to the team caring for at-risk patients.

Prevention and Treatment of Pressure Ulcers: Clinical practice guidelineis the relevant best-practice guidelines. These guidelines outline the components of, and techniques for, comprehensive skin and tissue inspections.

Implement a comprehensive wound management system that describes the protocols and processes for patient care when a patient’s pressure injury has been identified. Consider the assessment, treatment, monitoring and documentation of pressure injuries.

Ensure that assessment of pressure injuries incorporates:

  • The use of a validated risk assessment tool
  • The use of a pressure injury classification system
  • Assessment of pain using validated self-reporting tools such as verbal descriptor, visual analogue or numerical scales
  • Ongoing assessment that evaluates the effectiveness of the wound management plan.

Ensure that treatment addresses:

  • Pain management
  • Wound management
  • Adjunctive treatment options such as heel elevation, prophylactic dressings or electrotherapy
  • Referral to allied health when indicated, including dietetics or occupational therapy.

Conduct ongoing assessments of pressure injury risks and pressure injury healing, and documentation of all management plans, treatments and interventions provided.

Action 5.22

Clinicians providing care to patients at risk of developing or with a pressure injury conduct comprehensive skin inspections in accordance with best-practice time frames and frequency

Intent

The risk of harm from pressure injuries is minimised by routinely conducting skin inspections.

Reflective questions

What assessment tools or processes are used by the workforce to complete a comprehensive skin inspection for at-risk patients?

What processes are in place to ensure that prevention plans (including skin inspections) for patients at risk of a pressure injury are consistent with best-practice guidelines?

Key task

Develop or adapt a process to prompt clinicians to perform and document comprehensive skin inspections as part of routine patient care.

Strategies for improvement

Hospitals

Incorporate comprehensive skin inspections for patients who are screened as being at high risk of pressure injury into routine admission processes, as outlined in Action 5.11. For at-risk patients, conduct skin inspections on admission and on an ongoing basis, depending on the patient’s clinical needs. Best-practice guidelines provide recommendations on how often skin should be inspected.

Document the results of skin inspections in the healthcare record, as outlined in Action 5.12. When pressure injuries are identified, ensure that measurements and images are included in the documented wound assessment.

For patients at risk of developing a pressure injury or who have an existing pressure injury, integrate skin inspections into patients’ daily care plans, in line with Action 5.13.

Prevention and Treatment of Pressure Ulcers: Clinical practice guideline1 is the relevant best-practice guidelines. These guidelines outline the components of, and techniques for, comprehensive skin and tissue inspections.

Day Procedure Services

This action is not applicable for day procedure services that can demonstrate that they have had no pressure injury incidents in the past 12 months.

For other services, comprehensive skin assessment for patients screened as high risk for pressure injury should generally be incorporated into routine admission and discharge processes.

Refer to the hospitals tab for more detailed implementation strategies, as required.

Examples of evidence

  • Data on pressure injuries from the previous 12 months
  • Pre-admission screening documents addressing pressure injury risk.
MPS & Small Hospitals

Develop or adapt a process to prompt clinicians to perform and document comprehensive skin inspections as part of routine patient care.

Incorporate comprehensive skin inspections for patients who are screened as being at high risk of pressure injury into routine admission processes, as outlined in Action 5.11. For at-risk patients, conduct skin inspections on admission and on an ongoing basis, depending on the patient’s clinical needs. Best-practice guidelines provide recommendations on how often skin should be inspected.

Document the results of skin inspections in the healthcare record, as outlined in Action 5.12. When pressure injuries are identified, ensure that measurements and images are included in the documented wound assessment.

For patients at risk of developing a pressure injury or who have an existing pressure injury, integrate skin inspections into patients’ daily care plans, in line with Action 5.13.

Prevention and Treatment of Pressure Ulcers: Clinical practice guideline1 is the relevant best-practice guidelines. These guidelines outline the components of, and techniques for, comprehensive skin and tissue inspections.

Action 5.23

The health service organisation providing services to patients at risk of pressure injuries ensures that:

a. Patients, carers and families are provided with information about preventing pressure injuries

b. Equipment, devices and products are used in line with best-practice guidelines to prevent and effectively manage pressure injuries

Intent

Patients with or at risk of pressure injuries are provided with information and are involved in their pressure injury care, and devices and equipment that minimise the risk of harm are used.

Reflective questions

What processes are in place to ensure that equipment, devices and products are being used in line with best-practice guidelines to prevent and effectively manage pressure injuries?

What information and support are provided to patients about the prevention and management of pressure injuries?

Key tasks

  • Provide information for patients and carers about the prevention and management of pressure injuries.

  • Facilitate access to equipment and devices for the prevention and management of pressure injuries.

Strategies for improvement

Hospitals

Provide patient information

Patients, carers and families can help clinicians to prevent and manage pressure injuries. Provide patients, carers and families with information that will assist them to understand and take part in the development of effective and appropriate strategies, including information on:

  • Risk factors, preventing pressure injuries and self-care
  • How to gain access to credible electronic knowledge sites
  • How to change the environment to reduce risk
  • How to gain access to ongoing care.

Strategies to distribute information may include:

  • Providing brochures, fact sheets, posters, and other printed and online material
  • Providing opportunities for patients to discuss pressure injuries with clinicians on presentation for care and during care
  • Broadcasting prevention and management messages about pressure injuries on patient television and audio services.

Arrange access to products, equipment and devices

Access to products, equipment and devices can prevent pressure injuries or reduce harm when injuries have already been sustained.

To enable access to products, equipment and devices, consider:

  • Evaluating products, equipment and device requirements, usage and effectiveness
  • Determining the type and number of support devices the organisation may require and options for access to the equipment
  • Scheduling routine maintenance and coordinating repairs to maximise the availability of equipment
  • Developing guidelines on how to gain access to required equipment (for example, rental options).
Day Procedure Services

This action is not applicable for day procedure services that can demonstrate that they have had no pressure injury incidents in the past 12 months.

For other services, patients or carers should be provided with practical information about the factors that contribute to pressure injuries and how pressure injuries can be prevented.

Where day procedure services routinely provide care to patients who are at risk of developing a pressure injury, devices and strategies to prevent pressure injuries may be required.

Examples of actions that can be considered to facilitate access to equipment and devices include:

  • Evaluating requirements for, use of, and effectiveness of, equipment and devices
  • Developing guidelines on how to obtain required equipment (for example, rental options).

Refer to the hospitals tab for more detailed implementation strategies for this action.

Examples of evidence

Select only examples currently in use:

  • Register of equipment and devices
  • Guidelines for use of, and access to, equipment to prevent pressure injuries
  • Register of workforce training in the use and allocation of equipment and devices to manage pressure injuries
  • Reports of equipment use
  • Clinical audit of equipment use
  • Register of equipment maintenance and safety checks
  • Inventories of equipment, or guidelines on how to obtain required equipment (for example, rental options)
  • Committee and meeting records about the use of equipment and devices, and evaluation of the efficacy of products, equipment and devices
  • Patient and carer information packages or resources about preventing pressure injuries
  • Results of patient and carer experience surveys, and organisational responses, in relation to information provided about preventing and managing pressure injuries.
MPS & Small Hospitals

Provide patient information

Patients, carers and families can help clinicians to prevent and manage pressure injuries. Provide patients, carers and families with information that will help them to understand and take part in the development of effective and appropriate strategies, including information on:

  • Risk factors, preventing pressure injuries and self-care
  • How to gain access to credible electronic knowledge sites
  • How to change the environment to reduce risk
  • How to gain access to ongoing care.

Strategies to distribute information may include:

  • Providing brochures, fact sheets, posters, and other printed and online material
  • Providing opportunities for patients to discuss pressure injuries with clinicians on presentation for care and during care
  • Broadcasting prevention and management messages about pressure injuries on patient television and audio services.

Arrange access to products, equipment and devices

Access to products, equipment and devices can prevent pressure injuries or reduce harm when injuries have already been sustained.

To enable access to equipment and devices, consider:

  • Evaluating products, equipment and device requirements, use and effectiveness
  • Determining the type and number of support devices the organisation may need and options for access to the equipment
  • Scheduling routine maintenance and coordinating repairs to maximise the availability of equipment
  • Developing guidelines on how to gain access to required equipment (for example, rental options).
Last updated 5th July, 2018 at 07:34pm
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References

National Pressure Ulcer Advisory Panel, Panel EPUA, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: clinical practice guideline. 2nd ed. Perth: Cambridge Media; 2014.