3. An introduction to the SKIN Bundleand 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
4. An introduction to the SKIN Bundleand 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
5. An introduction to the SKIN Bundleand 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
6. An introduction to the SKIN Bundleand 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
7. An introduction to the SKIN Bundleand its Implementation
8. An introduction to the SKIN Bundleand 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
9. An introduction to the SKIN Bundleand 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
10. An introduction to the SKIN Bundleand its Implementation Safety Cross
11. An introduction to the SKIN Bundleand 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
12. An introduction to the SKIN Bundleand 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
13. An introduction to the SKIN Bundleand 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
14. An introduction to the SKIN Bundleand 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
15. An introduction to the SKIN Bundleand its Implementation ANY QUESTIONS?
