WoundsWest Wound Prevalence Survey 2011 The presence of wounds on patients in Western Australian public hospitals has been well documented between 2007 and 2009 with wound prevalence ranging between 49.5 to 41.6%. Between 2008 and 2009, WoundsWest identified a 14.9% reduction in hospital-acquired pressure injuries (PI) and skin tears; a significant improvement in patient safety and associated reduction in costs to hospitals and the community. In 2011, a fourth state-wide wound prevalence survey was undertaken the results of which show substantial increases in hospital-acquired pressure injuries between 2009 and 2011.
Key results at a glance 2011
2009
Change 2009 to 2011
Population 3,194
Patients consented to a full skin inspection
3,110
84 more patients
295
Staff & students received training to categorise wounds
318
23 less staff
100%
WA Health services participated
100%
Unchanged
42.9%
3.0% decrease
Wound Prevalence 41.6%
Wound prevalence (1 or more wound of any type: acute, burns, leg ulcers, malignant, pressure injuries, skin tears and other wounds)
Pressure ulcers 11.0%
Patients with1 or more pressure injuries
9.5%
15.8% increase
7.4%
Patients with 1 or more hospital-acquired pressure injuries
6.3%
17.5% increase
1
72.6%
Patients with a RAT performed within 24 hrs of admission
55.7%
30.3% increase
75.1%
Patients with a pressure injury who had a pressure relieving device insitu
84.4%
11.0% decrease
9.6%
Patients with 1 or more skin tears
9.2%
4.3% increase
5.9%
Patients had 1 or more hospital-acquired skin tear
5.9%
No change
22.6%
Potentially preventable hospital-acquired pressure injuries and skin tears
21.0%
7.6% increase
75.6%
Wounds with current documentation
75.8%
0.3% decrease
WA Staff & students accessing the WW Pressure Ulcer module
1112
141 more staff
WA Staff & students accessing the WW Skin Tear module
479
261 more staff
Skin tears
Wounds
Education modules 1253 740 1
Note: RAT – Risk Assessment Tool
Key Points:
7.6% increase in potentially preventable hospital-acquired pressure injuries and skin tears 17.5% increase in potentially preventable hospital-acquired pressure injuries 11% decrease in number patients with a pressure injury relieving device in place 30.3% increase in completion of pressure injury risk assessment on admission While clinical staff are more compliant in completing pressure injury risk assessments on admission increases in hospital-acquired pressure injury prevalence have occurred together with a decreased use of pressure relieving devices for patients with a pressure injury. This may indicate that nursing interventions based on patients pressure injury risk assessment scores are not being implemented on admission or after changes in patients’ clinical status.
Recommendations 1) Documentation: a) Investigate with Health Information Network the development and implementation of a state-wide electronic pressure injury identification process to accurately record hospital-acquired and non hospital PIs. 2) Economic burden pressure injuries: a) Given the continuing issue of PIs in WA Health it would be prudent to conduct an economic evaluation regarding the cost of PIs in WA public hospitals. 3) Clinical education: a) Investigate, in conjunction with key stakeholders, how to meet clinical staff needs to undertake ongoing PI education within the clinical setting. i) Mandatory PI education: (1) Completed within 3-6 months if a new employee. (2) Annual ‘refresher’ training for existing employees. b) Conduct workshops (face to face/online) to outline clinical risk of PIs using RAT, skin inspection, clinical judgment and related interventions to prevent PIs. c) Promote the Pan Pacific Clinical Practice Guideline for the Prevention & Management of Pressure Injury1. 4) Pressure relieving devices (PRDs): a) In consultation with SQuIRE, develop a video clip of the correct use of PRDs and correct patient positioning when placed on these devices for hospital intranets and WoundsWest’s online Pressure Injury Module. b) Conduct a PRD audit during the next state-wide wound prevalence survey. c) Posters – develop quick reference guidelines for allocation and use of PRDs. 5) Patient awareness/accountability for skin integrity: a) In consultation with SQuIRE, produce a video clip on pressure injury prevention for patients, families and carers to be viewed on hospital patient TV channels and WoundsWest’s forthcoming online Health and Wellbeing Module. 6) National Safety &Quality Health Care Service Standards: Preventing & Managing Pressure Injuries Standard 82: a) Promote Standard 8 at all available opportunities. b) Monitor WA Health Services’ compliance with Standard 8. 7) Pressure Injury incidence monitoring: a) Collaborate with SQuIRE to conduct a pressure injury incidence survey immediately after next statewide wound prevalence survey in either all or selected hospital sites. b) Conduct random ‘walk through’ pressure injury incident audits in selected hospital sites.
Resources More information on WoundsWest and more detailed survey reports can be found at www.health.wa.gov.au/woundswest. WoundsWest’s Advisory Service and online Education Program provide access to information and education on evidence-based best practice in wound care. WoundsWest Advisory Service: 1300 WOUNDS Email:
[email protected] 1
Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury Draft Consultation; www.awma.com.au 2 Australian Commission on Safety and Quality in Health Care, National Safety and Quality Health service Standards: Preventing and Managing Pressure Injuries Standard 8; www.safetyandquality.gov.au
