JUNE 2022
EDITION 15
NSLHD PRESSURE INJURY POINT PREVALENCE AUDIT (PIPPA)
Clinical procedures are performed multiple times across every service setting in NSLHD. Preventing incidents of incorrect patient, incorrect procedure or incorrect site associated with clinical procedures is critical to patient safety and the quality of clinical care we provide. The Clinical Procedure Safety – NSLHD Procedure has recently been made available to provide NSLHD clinicians with practical applications to address clinical care and patient safety risks associated with clinical procedures. The new procedure supports our district in complying with the NSW Health Clinical Procedure Safety policy directive (PD2017 032) and In addition to the Procedure, other resources are now also available on the Clinical Procedure Safety intranet page, including a decision support tool that provides guidance to define the Clinical Procedure level and corresponding necessary safety requirements; and a Clinical Procedure Safety Poster that provides an overview of the four steps (verification, matching information, time-out, post- procedure confirmation and documentation) to be completed to ensure safe clinical procedures are performed. the NSQHS Clinical Governance and Communicating for Safety Standard. CLINICAL PROCEDURE SAFETY
The most common pressure injury stages are stage 1 (non-blanching erythema or intact skin) and stage 2 (partial thickness skin loss). Heels and sacrum remain the most common sites for pressure injury development. There is a mismatch ordering pressure redistribution support surfaces for patients with an active pressure injury. Less than 40 per cent of patient medical records documented pressure injury prevention consumer engagement and education. Throughout our district, staff work tirelessly to prevent and minimise avoidable pressure injuries for our patients. The Pressure Injury Point Prevalence Audit (PIPPA) is the annual snap-shot review of pressure injury prevalence and severity across our sites and services. Findings from this year’s audit indicate that overall, NSLHD has demonstrated a reduction in pressure injury prevalence since 2018. However, while overall pressure injuries prevalence has decreased, hospital acquired point prevalence has increased by 0.44 per cent, indicating that a pressure injury developing is more likely to be acquired in hospital. Additional findings from the audit include: The findings determine opportunities to further enhance the care we provide to reduce the risk to our patients in developing a pressure injury. This includes enhanced staff education and training to reinforce the need to complete pressure injury risk screening within the first eight hours of patient hospital admission, as well as enabling clinicians to inform and partner with patients and their loves ones, so as to prevent the development of pressure injuries while in hospital. In addition, the Skin Integrity Committee will review support surface ordering and management to ensure that patients at risk of pressure injury are provided timely access to the right support surfaces as required. Contact: Lizanne.Dalgleish@health.nsw.gov.au (A/Skin Integrity Improvement Facilitator) for further information.
Click on image to download full poster or access from the CPS Intranet page
Ongoing work to integrate clinical procedure safety requirements into clinical documentation in the eMR continues. The documentation processes for clinical procedure safety requirements as determined and followed by the facility, service, specialty or department will remain current until the release of new integrated and optimised documentation in eMR. The first change to be introduced in eMR will be found in iView - Access Devices, Lines, Tubes and Drains. Contact: Jillian.Moxey@health.nsw.gov.au (Service Development Manager, Surgery and Anaesthesia Network)
Communicating for Safety Standard
Comprehensive Care Standard
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