The impact of a CNS in tissue viability on the reduction of pressure ulcers in care

of the older person setting

Maree Barry

RGN, HdipTissue Viability,

PG:PEPPD, RNP

St Mary’s Hospital

Phoenix ParkEPUAP & NUAP 2009

Pressure Ulcers

EPUAP & NUAP 2009

Pressure Ulcers cause great pain and suffering Gorecki et al (2009), Hopkins et al (2006)

The incidence and severity of preventable pressure ulcers is a key indicator of quality of care Benbow and Bateman (2012)

Pressure Ulcers

EPUAP & NUAP 2009

Mean pressure ulcer prevalence ratesin Ireland 16% (4 - 37%) n = 6

Mean pressure ulcer incidence ratesin Ireland 11% (8 – 14%) n = 4 Moore et al (2013)

The Role of CNS in Tissue Viability

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The CNS in tissue viability plays a key role in the prevention of pressure ulcers Guy et al (2010) It is well documented that the CNS improves patient outcomes and quality of care

Very little evidence to support this Doody and Bailey (2011)

Study Aim </p>

EPUAP & NUAP 2009

Explore the impact of CNS in tissue viability in the reduction of pressure ulcers in care of the older adult setting

Methods

EPUAP & NUAP 2009

Incidence, prevalence and healing rates monitored since 2007

Data collected by purposeful sampling through direct referral to TVN

Retrospective

The TVN EMPOWER Model

EPUAP & NUAP 2009

E – Education

M – Motivate

P - Prevalence, incidence and healing

O - Other professionals W – Who

E – Enable

R - Results

Education

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•Link Nurses/Healthcare assistants•Ward based education for all staff members •Formal education for multidisciplinary team•Student nurses•Medical students•Residents and families•Opportunistic teaching sessions•Documentation•Reporting

Motivation

EPUAP & NUAP 2009

•Work closely with frontline staff•Communication•Passion•Enthusiasm•Support•Trust and respect•Role Model•Identify positive outcomes•No Blame•Encourage

Prevalence

EPUAP & NUAP 2009

Prevalence

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

2007

2008

2009

2010

2011

2012

2013

%

Incidence

EPUAP & NUAP 2009

Incidence

0

5

10

15

20

25

30

35

2007

2008

2009

2010

2011

2012

2013

%

Severity

EPUAP & NUAP 2009

Grade 4

0

2

4

6

8

10

12

2007

2008

2009

2010

2011

2012

2013

%

Other Professionals

EPUAP & NUAP 2009

•The input from the multidisciplinary team is essential in pressure ulcer prevention•Co-ordinated team planning, implementation and evaluation is necessary to ensure the patient receives holistic high standard quality care•Improved communication between disciplines improves patient outcomes•Gain respect and insight into each disciplines knowledge and skills

Who

EPUAP & NUAP 2009

•Skin Assessment•Risk Assessment •Mobility•Nutrition•Incontinence•Age•Tissue tolerance•Manual Handling•When risk identified appropriate interventions implemented•Documentation

Enable

EPUAP & NUAP 2009

•Skills and knowledge•Enabling not disabling/de-skilling•Competence•Confidence•On-going education•On-going support•Encouragement•Communication•Availability of resources•Empower

Results

EPUAP & NUAP 2009

•Overall reduction in the prevalence of pressure ulcers from 4.6% to 2.3%

•Overall reduction in the incidence of hospital acquired pressure ulcers 18% to 6.6%

•Overall reduction in grade 4 pressure ulcers from 5.6% to 0.3%

•Average age of population 80

Conclusion

EPUAP & NUAP 2009

Since the introduction of the CNS in tissue viability there has been a marked reduction in prevalence and incidence of pressure ulcers demonstrating the positive impact of this role on patient care. The study also identified a significant decrease in the number and severity of hospital acquired pressure ulcers

Pressure Ulcer Collaborative

EPUAP & NUAP 2009

Pressure Ulcer to Zero is a National Quality ImprovementProgramme22 Pilot sites in Meath, Louth, Cavan, Monaghan and NorthDublin, across many settings, acute hospitals, primary careCentres, nursing homes and other community and privateResidential settingsAim is to reduce the incidence of avoidable pressure ulcersinitially by 50% and ultimate goal is 0%

Thank You

EPUAP & NUAP 2009

References

EPUAP & NUAP 2009

Benbow,M., Bateman,S 2012 Working towards clinical excellence -Pressure ulcer prevention and management in primary and Secondary care. Journal of Wound Care 21:(9): S25-S39Doody.O, Bailey.M, 2011 The development of clinical nurse specialist roles in Ireland. British Journal of Nursing 20:(14)868 – 872EPUAP/NUAP 2009, www.epuap.orgGorecki,C., Brown,J.M., Nelson,E.A., Briggs,M.,Schoonhoven,L.,Dealey,C., Defloor,T., Nixon,J 2009 Impact of pressure ulcers on quality of life on older patients: a systemic review. Journal of the American Geriatrics Society,57: 1175-83Guy,H,. Downie.F,. McIntyre.L, 2013 Pressure ulcer prevention: making a difference across a health authority? British Journal ofNursing (Tissue Viability Supplement) 22: (12),S4 – S13Hopkins.A,. Dealey.C,. Bale,S,. Defloor. T,. Worboys.F,2006 Patient stories of living witha pressure ulcer. Journal of Advanced Nursing 56: 345-353Moore,Z,. Johanssen.,E, Van Mitten,M. 2013 A review of PU Prevalence and incidence across Scandinavia, Iceland andIreland (Part 1), Jornal of Wound Care, 22: (7), 361 - 368