Clinical innovations


NewsWounds update Pressure ulcer update


Wounds International clinical updates present recent developments in the field of leg ulcers, pressure ulcers, skin integrity and diabetic foot, including the latest from associations, clinicians and industry. If you use an innovative technique in your practice that you would like us to feature in future issues, please email the editor at: scalne@woundsinternational.com


Monitoring incidence and outcomes of pressure injuries


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Authors (clockwise from top): Joanne Hardy, Sunita McGowan, Aileen Hulbert.


his report summarises some of the information presented during a session at the Australian


Wound Management Association conference in Sydney, Australia, in March 2012. It outlines a data collection process conducted as part of an ongoing pressure injury project within Fremantle Hospital and Health Service — a 450-bed, acute care, tertiary health service, located across


two campuses in Western Australia. Fremantle Hospital and Health


Service has a long history in pressure ulcer prevention and management. With the introduction of a national


incident reporting system in the early 2000s, it was recognised that clinical staff needed to be engaged in the


reporting process so that meaningful incidence data could be collected. In a collaborative effort between the Department of Nursing Research and Evaluation and the Clinical Governance Unit, a telephone reporting system was initially introduced in 2003 to expedite the process for clinical staff. Timely follow up of the reported incident allowed for verification of the report and senior staff to be involved earlier in patient management. Over time, the process evolved into a exceptional


collaboration between clinical staff, Nursing Research, Nursing Informatics, Stomal Therapy, Medical Illustrations, clinical nurse managers, Staff Development, Clinical Governance and Clinical Coding. An intranet-based reporting system replaced the telephone reporting system in 2005 to further simplify the routine reporting and follow-up of stage two and above pressure ulcers and more recently it has been upgraded to include skin tears. Clinical staff report incident data at ward or unit level, which are electronically written to a locally developed


10 Wounds International Vol 3 | Issue 3 | ©Wounds International 2012


application called the Pressure Area Reporting and Information System and Skin Tear Audit Research (PARIS*STAR). While this application also captures and assists with the management of skin tears, the focus of this report is on practice initiatives and data that relate to pressure injury prevention and management. To appreciate the depth of work undertaken by the hospital


to understand pressure injury development, it is necessary to mention a few of the in-house resources that are available to staff and/or patients. These include policy and practice guidelines, a knowledge-based questionnaire completed by all nursing staff at orientation, end of bed references, a Microsoft PowerPoint presentation and self-directed learning package, as well as a patient information sheet exist. Additional measures include a prompt that asks if a short


message service (SMS) request for an alternating pressure relieving mattress needs to be sent to the Equipment Pool when nursing staff enter a low Braden Score into an electronic handover sheet[1]


. The automation of this process speeds up


the time taken to get an alternating pressure-relieving mattress to the high-risk patient. Staff can also send an e-request for a photograph to Medical Illustrations to ensure that an electronic record of the wound is available to clinical staff throughout the admission. This limits the need for dressings to be taken down so that the progress of the wound can be determined. The detail of all reported pressure injuries entered by clinical


staff is automatically captured by the in-house database (PARIS*STAR) created by the Nursing Informatics Department and a first review report is generated. Senior nursing staff in Nursing Research review reports and forward details of the more severe injuries to Stomal Therapy for immediate expert review. Stomal Therapy continue to review stage three and four pressure injuries at least once a week and guide the nursing management of the wound during admission and when preparing the patient for discharge. The first review form generated using PARIS*STAR and used


by Nursing Research and Stomal Therapy includes areas for adding contributing factors, verifying the severity of injury, preventative strategies in place and current management. The additional data are collected when the patient’s skin injury is verified by senior clinicians within 24 hours of report and includes the determination of whether appropriate treatment strategies are in place. All data are entered into PARIS*STAR and available for ongoing analysis.


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