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Problem Statement

This year, a predicted 55,000 New Zealanders will acquire pressure injuries. As the majority of pressure injuries are preventable, there has been a high priority placed on their reduction.

Pressure injuries are one of the leading causes of preventable harm in the inpatient setting. Hospital-acquired pressure injuries can reduce the quality of life for those suffering from them, as well as negatively affecting mental wellbeing. The human cost is significant, including ongoing pain, reduced mobility, social isolation, depression, prolonged hospital admission and in some cases even death. The fiscal implications of pressure injuries within New Zealand are also vast, with an estimated $694 million per year being spent on treating them.

CM Health has been actively involved in pressure injury prevention for the past decade, and although there have been significant reductions in the number of pressure injuries occurring, they are still present. In 2018, a partnership established between CM Health and ACC has enabled the recruitment of a clinical nurse specialist who is able to identify areas of concern relating to pressure injuries, and focus on education and implementing appropriate interventions.

What are we trying to achieve?

Pressure injury prevention is important within inpatient settings, as early identification of a pressure injury, and appropriate use of pressure relieving equipment, can stop the progression of pressure injuries. Our goal is to ensure there is a consistent and high-quality approach to the identification, risk assessment, prevention and treatment of pressure injuries – building on the expertise and learning from working on this aspect of patient harm for more than a decade.

We are aiming for an integrated approach across the sector, which is why the second phase of our partnership with ACC is focused on preventing pressure injuries with the Adult Rehabilitation Centres. This is being done by supporting the centres through a virtual clinic, and ongoing education sessions, to empower the centres to reduce their instances of pressure injuries.

What have we done?

Additional funding has enabled a pressure injury prevention clinical nurse specialist role to be established; providing strong clinical leadership, which the research shows is imperative for successful pressure injury prevention.

Last year, we achieved seven milestones through the ACC partnership and one that was rolled over to the following year, as there needed to be further analysis of that milestone.

 Some of the successes over the past year have been:

  • implementation of an organisation-wide heel protector boot
  • implementation of Dermapad
  • successful engagement of a pressure injury prevention working group (monthly) and steering group (quarterly)
  • analysis of Virtual Clinic, which has been an opportunity to engage with the Adult Rehabilitation Centres
  • introduction of a new auditing process for the community prevalence audit.

What did we find?

The heel protector boot was rolled out across the organisation in September 2018 and has already made a positive impact on reducing pressure injuries within the inpatient setting.

  • Time – the heel protectors are now available on the wards, so the pressure can be offloaded as soon as it is identified, rather than waiting for Orthotics to supply protectors, as was previously the case.
  • Savings – the boots are $50 to $80 cheaper than the previous heel boot used.
  • Independence – the new heel boots have a slim profile and non-slip sole, so patients can safely mobilise in them.
  • Hygiene – the new heel boots can be wash and line dried if they become contaminated, whereas the previous heel boot would have to be disposed of.

How did we make a difference?

As can been seen from the following graphs, there has been a 70% reduction in suspected deep tissue and unstageable heel pressure injuries since the introduction of the new heel protector boots. This reduction shows that although there are still Stage 1 and Stage 2 pressure injuries being reported, early intervention using the heel boots is preventing the progression of the pressure injuries, which ultimately saves money through reduced lengths of stay.

Where to from here?

We know that we will get better outcomes if the health board, Adult Rehabilitation Centres and community care providers work closely together to improve pressure injury prevention and management. Taking a consistent approach through using a single guide needs to be the clinical foundation.

We will take a phased approach to achieving this. Our first step will be to engage with CM Health, Adult Rehabilitation Centre and community providers and clinical leads to assess their needs and the current state of pressure injury incidence and prevention across the Counties Manukau region, and to agree on useful strategies to trial within the Adult Rehabilitation Centre.

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