Baseline Assessments Hospital: Pressure ulcer Incidence 8-13% Pilot Ward (Anglesey): Baseline incidence rate - 4.5% Nutritional assessment - 50% Pressure risk assessment - 80% Source: spot audit March ’08 An introduction to the SKIN Bundle and its Implementation

Preparation for Culture Change Set up multi - professional project team Staff Briefing and brainstorm Develop ‘SKIN Bundle’ into communication tool Agree metrics Educate staff with TVN support Ensure PU prevention is given high priority e.g. team briefing, posters, visual cues Develop patient information leaflets Patient involvement is essential An introduction to the SKIN Bundle and its Implementation

What is the SKIN Bundle of care? Surface Mattress and Cushion Include safety checks Sheet checks, wrinkles etc. Reassess Waterlow score at least daily Keep Moving Reposition patient Inspect skin Encourage mobility Written advice for patient and carers An introduction to the SKIN Bundle and its Implementation

What is the SKIN Bundle of care? Incontinence Toileting assistance Continence products Seek specialist advice Keep clean and dry Nutrition Nutritional risk tool Follow instructions Ensure optimal intake Use of charts if required Keep well hydrated An introduction to the SKIN Bundle and its Implementation

An introduction to the SKIN Bundle and its Implementation

Pilot ‘SKIN Bundle’ Address risk scoring documentation – set 100% compliance, daily review Deming's PDSA methodology commence with small client group: “Model for Improvement” Audit SKIN bundle communication tool – daily Make it part of the ward fabric An introduction to the SKIN Bundle and its Implementation

Outcome measures [Metrics] Document pressure ulcers of all grades (I – IV) on Safety Cross Count “days since last pressure ulcer developed on this ward” and display on Safety Cross Incident form for any ulcer grade II and above Calculate rate per 1000 bed-days Monthly audit compliance of risk assessments An introduction to the SKIN Bundle and its Implementation

Patient admitted with PU Safety Cross 1 2 3 4 5 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Days since last PU 27 28 ___ days 29 30 31 No new PU Ward acquired PU Patient admitted with PU An introduction to the SKIN Bundle and its Implementation

Aim for success 100% compliance with risk score Manage the risk score consistently Use SKIN Bundle communication tool with Patient involvement Written patient information and education leaflets An introduction to the SKIN Bundle and its Implementation

It is now an adverse event! Pressure ulcer occurred on Jan 25th 2010 Grade 2 PU Incident form filled in as per policy Outcome - PU healed within 4 days Critical analysis took place Was patient assessed properly Had assessment plan been maintained Could something have been done differently An introduction to the SKIN Bundle and its Implementation

Keys factors – to success Communication tool – patient partnership Staff education and engagement – all staff groups “Model for Improvement” Create a “Culture of Change” not just about a document Risk scoring and managing those scores Tissue Viability Nursing support Team approach with clear executive engagement An introduction to the SKIN Bundle and its Implementation

Spreading the intervention Plan and manage using a multi-professional project team Use cycles of change when required Quick wins are important– success breeds success Give yourself clear aims that are SMART An introduction to the SKIN Bundle and its Implementation

ANY QUESTIONS? An introduction to the SKIN Bundle and its Implementation