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An introduction to the SKIN Bundleand its implementation

16th June 2010

Presenter: Nigel Broad Charge Nurse

Reduce the Percentage of Hospital acquired Pressure

Ulcers(per 1000 patient

days By 50% by

2010 Identification, grading

of pressure ulcers existing on admission /transfer & appropriate

intervention

Assess pressure ulcer risk on admission for ALL patients Re-assess skin every 8 hours where necessary Initiate and maintain correct and suitable preventative measures

Understand the risk factors for acquiring pressure ulcers Understand the local context & analyse local data to assess patients on ward/unit most at risk Utilise patient ‘At risk’ cards to quickly identify those at increased risk

Risk Assessment

Risk Identification

Reliable Implementation of the

SKIN ‘bundle’ ‘Ascension health’s

initiative 2004’

Address these areas: Surface Keep Moving Incontinence Nutrition

Initiate and maintain correct and suitable treatment measures Utilise the local Tissue Viability nursing expertise

Content Area Drivers Interventions

Educate staff regarding the assessment process, identification and classification of, and treatment of pressure ulcers Educate Patients & family Develop patient information pack

Education

An introduction to the SKIN Bundle and its Implementation

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

Safety Cross1 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

1. Grade 2 PU

2. Incident form filled in as per policy

3. Outcome - PU healed within 4 days

4. Critical analysis took place

1. Was patient assessed properly

2. Had assessment plan been maintained

3. 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?