ISSUE 5, November 2013

A Message

Table of

Contents

1.

FOCUS ON Pressure InjurIes & InconTInence AssocIATed derMATITIs (IAd)

from the editorsWelcome to Our Biggest Issue!Welcome to this edition of our RISE Newsletter with the focus on pressure injuries and Incontinence Association Dermatitis (IAD) – our biggest edition yet!

This is a timely edition with the Worldwide STOP Pressure Injury (Ulcer) day in November. This initiative started in 2012 following a meeting of Spanish speaking wound care organisations who agreed and signed the Declaration of Rio. It aims to increase awareness of pressure injuries amongst the public, medical professionals and politicians. The European Pressure Ulcer Advisory Panel (EPUAP), acknowledging and applauding this work, joined and encouraged countries internationally to participate.

We all understand the negative impact that a pressure injury has, not only in terms of cost and resources but more importantly to the individual and its profound impact on a person’s health. IAD is often an unknown skin injury – albeit we all see or have seen in our clinical practice. We would pose the question to you – has IAD ever been misreported as a pressure injury or even not reported, prevented or managed appropriately?

In June this year 3M held an inaugural Skin Integrity Forum in Sydney titled “Raising the awareness and delivering excellent care in the areas of pressure injury prevention and Incontinence Associated Dermatitis (IAD) management.” The Forum was chaired by Professor Keryln Carville and aimed to facilitate local and international speakers to discuss current research, trends, evidence and future strategies in pressure injuries and IAD management. The end result provided a five hour educational webinar reaching over 800 clinicians in nine countries including Australia, New Zealand, Malaysia, Thailand, India, Korea, Taiwan, China and Singapore.

With the launch of the 2012 Pan Pacific Pressure Injury Guidelines and the implementation of Safety and Quality Initiatives to improve quality of health care across Australia and New Zealand, these topics are at the forefront of our minds. The quality and content of the presentations was outstanding with incredible feedback and so this issue provides summaries of the presentations as well as an opportunity for you to listen to these sessions - either for the first time or again!

In this edition we also feature two conference reports – the first from the 2nd Annual Reducing Avoidable Pressure Injuries Conference held in Melbourne and the second from the National Continence Foundation of Australia Conference held in Perth.

The 3M RISE (Reducing the Incidence of Skin breakdown through Education) Programme continues to go from strength to strength and provide you with the tools and resources to implement skin care incontinence programmes and protocols in your organisations that help reduce the incidence of skin breakdown. Research such as detailed in the Skin Integrity Forum shows us that the use of product alone will not give us the desired health outcomes that we seek without a defined skin care programme and protocols of care that are adhered to through a structured, well executed educational programme.

We wish you and your families a wonderful festive season.

Best Wishes,

Vicky and PaulaRNs / Technical Specialists Critical & Chronic Care Solutions Division3M Australia & 3M New Zealandvmoss2@mmm.com pmassey@mmm.com

A Message from the Editors

1

Diary Dates 2

2nd Annual Reducing Avoidable Pressure Injuries Conference

3

22nd National Conference on Incontinence

4

Skin Integrity Forum Session Summaries 5 - 12

Moisture Lesions vs Pressure Injuries

15

Prevention Makes Sense

17

Introducing 3M’s RISE Program

18

2.

Australia and New Zealand Events

Australian and New Zealand Intensive Care Society

Conference (ANZIC) 12th - 14th March 2014

Rydges Latimer Hotel, Christchurch, NZ

http://www.anzics2014.co.nz/

10th Australasian Lymphology Association Conference

3rd – 5th April 2014

Auckland, New Zealand

http://alaconference.com.au/

Australian Wound Management Association (AWMA)

National Conference7th – 10th May 2014

Gold Coast Convention and Exhibition Centre, Gold Coast,

Australiahttp://www.awma.com.au/conferences/index.php

23rd National Conference on Incontinence

10th - 13th September 2014

Cairns Convention Centre, Cairns, Australia

Joint meeting with the International Children’s Continence Society

(ICCS) and UroGynaecological Society of Australasia (UGSA).

http://www.awma2014.com.au/

3MTM CavilonTM No Sting Barrier Film wins most innovative product for ostomy care.3M ‘s Critical & Chronic Care Solutions Division is currently celebrating the success of 3MTM CavilonTM No Sting Barrier Film after the product has won a patient-nominated award for the ‘Most Innovative Product’ for ostomy care.

Hosted annually by UK charity Ostomy Lifestyle, the awards highlight professionals, volunteers, support groups and products which improve

the experiences of patients after stoma surgery.

Cavilon No Sting Barrier Film has been recognised for its ease of use and “working wonders on fragile skin healing around the stoma site”.

Cavilon No Sting Barrier Film forms a waterproof protective film which can be applied to intact or broken skin around the stoma without stinging. The alcohol-free formula offers gentle yet effective protection and comes in a wide range of formats including a spray and convenient stoma wipe.

3M is delighted that Cavilon No Sting Barrier Film is so highly valued by patients ostomy patients and that we are able to make a difference

to the lives of those patients living with stomas.

diary dates

Future International Conference DatesWOCN Society’s 47th Annual ConferenceJune 6th – 10th 2015San Antonio, Texas, United States

WOCN Society’s 48th Annual ConferenceJune 4th – 8th Montreal, Quebec, Canada

International EventsWound, Ostomy, Continence Nurses (WOCN) Society 46th Annual Conference21st – 25th June 2014Nashville, Tennessee, USA

Symposium on Advanced Wound Care and Wound Healing Society (SAWC/WHS) 23rd – 27th April 2014 Gaylord Palms Resort & Convention Center, Orlando, Florida, USA

Infusion Nurses Society (INS) Annual Convention3rd – 8th May 2014Phoenix, Arizona, USA

We would like to understand you better...We’d like to better understand how you use perineal cleansers in your clinical practice so that we can do a better job of providing solutions that help to prevent Incontinence Associated Dermatitis (IAD) and pressure injuries and so that we can help make your job easier.

Please take the time to complete our short questionnaire. It should only take a few minutes for you to complete.

We appreciate that your time is very precious so in recognition of your time, the first 50 responses will receive a copy of the Wound, Ostomy and Continence Nurses Society publication: Incontinence Associated Dermatitis (IAD): Best Practice for Clinicians. Please don’t forget to leave your details so that if you are one of the first, we are able to send your copy to you.

Click here to complete our Cleansing Practices Surveyhttps://www.surveymonkey.com/s/cleansingpractices

3.

ISSUE 5, November 2013

Melissa Ward (RN, Cert IV TAE) Clinical Nurse Educator Sydney Adventist Hospital

Melissa has a keen interest in wound care and is currently undertaking a Graduate Certificate in Wound Management through Monash University. Melissa is the coordinator for the Wound Management workshop series that is offered by the hospital. Melissa is a member of the Preventative Strategies Committee. She is a member of AWMA; has presented at state AWMA conferences and was recently in Copenhagen at EWMA in May this year.

The second annual Reducing Pressure Injuries Conference was a two day event, was held in Melbourne from 16th – 17th September and was followed by a Workshop on the 18th of September. The conference was well attended and the number of delegates was estimated to be triple that of the number of delegates who attended last year.

The conference was based on a series of comprehensive case studies from a wide variety of clinical areas and aged care facilities. Highlights from the presentations and discussions included topics relating to: Standard 8; peri-operative risks; the importance of skin care; risk assessment and prevention strategies for the ICU patient; preventing Incontinence Associated Dermatitis (IAD); creating wound care champions in clinical areas; and the importance of patient/family involvement in pressure injury education.

The range of topics included in the agenda offered insight, solutions and challenges. It was fabulous to hear the strategies and plans that many hospitals had put in place and to learn of their struggles and achievements.

The conference not only provided vital networking opportunities but allowed clinicians to share their experiences, failures and successes in dealing with pressure injury prevention. It allowed trade to present specific technologies designed for pressure injury prevention and have personal discussions with clinicians.

There was so much information shared but a few take home messages for me included:

• Pressure injury prevention is an organisations’ role not just the nurses role

• Initial and ongoing engagement with staff is key

• Value intact skin; don’t wait for redness to occur before prevention techniques are adopted- think of it like sunscreen – don’t expose skin to urine/faeces without protection.

My colleague Linley and I really enjoyed the conference and have come back to work with tangible ideas for change within our own organisation. We also came back with new shoes and earrings – an expectation after a conference in Melbourne!!!!

2nd Annual reducing Avoidable Pressure Injuries conference

did you know?

Bale s, Tebble n, jones Vj, Price Pe. The benefits of introducing a new skin care protocol in patients cared for in nursing homes.(2004) j Tissue Viability 14(2): 44–50.

Studies have shown that older people are more prone to incontinence.

In one study, 29% of older people cared for in a nursing home were incontinent of urine, 65% were doubly incontinent, 6% were catheterised

4.

did you know? Best Practice statement. care of the older Person’s skin. London: Wounds uK,

2012 (second edition).

Even minor skin injury can create discomfort and pain and add to patient suffering

22nd national conference on IncontinenceCrown Perth Convention CentrePerth 23-26 October 2013It had been nine years since the 2004 13th National Conference at the Esplanade Hotel, Fremantle WA. It was fitting therefore, that the 22nd National Conference be held in Perth. Canvassing for Perth began back in May of 2011, at the Melbourne CFA Board meeting with WA Board members, myself, Lesley Barton and Glen Wilson. I suppose we put forward a convincing argument as the Board agreed to hold the 22nd National Conference on Incontinence in Perth, October 2013.

The Scientific Committee was put together in June 2011 and planning began almost immediately. After more than two years in the making, the Conference was held from 23 to 26 October 2013.

There were more than 600 delegates and 44 trade companies attending the conference and the topics discussed were varied and covered all disciplines. The scientific papers that were presented were of a high standard and challenged all to question whether or not our practice “is it evidence based”?

Keynote speakers included in the agenda included: Professor Peter Lim from Singapore; Dr Jean Hay-Smith from New Zealand; Nick Haslam from Melbourne; Assoc Professor Caroline Gargett from Melbourne; and Dr Martha Lee from Singapore.

The feedback from delegates has been extremely positive and the Crown Perth Convention Centre proved to be an excellent venue.

Darryl Kelly, Continence Advisor

SCIMWA

Darryl KellyDarryl Kelly has over 30 years national and international experience as a specialist nurse in the area of spinal cord injuries. He is passionate, dedicated and committed to working with people to problem solve each case, while making a significant difference to the quality of their lives.

Daryl works for Spinal Cord Injuries Management (SCIMWA - www.scimwa.com.au). This is a unique 24 hours a day, 7 days a week service specialising in the specific needs of people living with spinal cord injuries, their family and their careers.

SCIMWA's aim is to provide people living with spinal cord injuries a specialist community health care service that includes the client in the consultation and decision-making process, promotes a level of independence, and provides strategies to maintain a healthy lifestyle within a community setting.

Darryl Kelly Qualifications:

Hospital-based General Nursing, Darwin, NT, 1976.

Post-basic Spinal Course, WA School of Nursing, 1979.

Bachelor of Science Nursing, Curtin University, 1992.

Post-Graduate Diploma of Nursing, Curtin University, 1997.

Continence Nurse Consultant Certificate, Curtin University, 1997.

Certifi cate IV in Assessment and Workplace Training, 2003.

5.

ISSUE 5, November 2013

In June this year 3M held an inaugural Skin Integrity Forum in Sydney titled “Raising the awareness and delivering excellent care in the areas of pressure injury prevention and Incontinence Associated Dermatitis (IAD) management.” The Forum was chaired by Professor Keryln Carville and aimed to facilitate local and international speakers to discuss current research, trends, evidence and future strategies in pressure injuries and IAD management. The end result provided a five hour educational webinar reaching over 800 clinicians in nine countries including Australia, New Zealand, Malaysia, Thailand, India, Korea, Taiwan, China and Singapore.

Provided for you below are the short biographies from each of the speakers and summaries of each of their presentations at the Skin Integrity Forum. We invite you to read the summaries and listen to the recorded sessions from each presentation at your leisure.

Debra Thayer MS, RN, CWOCN

Debra Thayer is a board certified Wound Ostomy and Continence (WOC) Nurse with over 20 years experience in the specialty.

She holds a Baccalaureate degree in Nursing from the University of Wisconsin, and a Master’s Degree in Nursing from the University of Minnesota. She has provided wound, ostomy and continence care as a clinical specialist in hospitals, nursing homes and home health care. Prior to joining 3M as a Skin and Wound Care Specialist, she had a private nursing practice that included patient care and industry consultation.

Debra has participated in research and has published. Her most recent publication “Skin Care Considerations in IV Therapy” was published in the Journal of Infusion Nursing in the November/December 2012 issue.

Skin care, incontinence and wound infection are areas of special interest. Debra is a member of the Wound, Ostomy and Continence Nursing Society. In her current role she has lectured on skin and wound related topics across the US, Asia/Pacific, Latin America, Europe and the Middle East.

Associate Professor Fiona Coyer

School of Nursing, Faculty of HealthQueensland University of Technology

Dr Fiona Coyer is Associate Professor and Director of Academic Programs in the School of Nursing, Queensland University of Technology (QUT). Her responsibilities include overseeing strategic direction of the undergraduate and postgraduate programs in the School.

Fiona completed her PhD in 2004. Her research interests include patients and families perspectives of intensive care and maintaining skin integrity for the critically ill patient.

Fiona has a Research Fellow appointment to the Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital (RBWH) and in 2012 Fiona established the RBWH/QUT Intensive Care Nursing Professorial Unit.

Jill Campbell RN, BApp Sc (Nursing), GradCert (Sexual Reproductive

Heath) GradDip (Intensive Care), GradDip (Wound Care), MACN

Jill has been a registered nurse for over 30 years. She has had a diverse career with experience in intensive care, cardiology, women’s health, aged care and wound care.

Currently, she is a Skin Integrity Clinical Nurse at Royal Brisbane & Women’s Hospital. Her special skin integrity interests are in the area of Incontinence Associated Dermatitis and Pressure Injury Prevention and Management. She is a member of the Small Working Group for Older Adults for the 2014 International Pressure Ulcer guideline review.

She has completed a Graduate Diploma in Wound Care. At present, Jill is undertaking a Master of Applied Science (Research) and will be articulating to a PhD later this year. Her doctoral studies will investigate the relationship between candida and IAD aetiology. She has conducted research to determine the prevalence of incontinence associated dermatitis in the acute health care setting, the only such study that has been conducted in Australia. She presented her IAD prevalence study at the 4th Congress of the World Union of Wound Healing Societies in Japan late last year. She is the recipient of a 2013 RBWH Foundation grant to further this unique research.

Dr. Karen E Campbell RN, PhD

BScN University of WindsorBA (psychology) University of WindsorMScN University of TorontoCertificate as a Nurse Practitioner University of Western OntarioPhD University of Western Ontario

Karen has functioned as an advanced practice nurse in psychiatry, continence, wound care and geriatrics. Currently she is field leader for the Master’s of Clinical Science in Wound Healing at Western and Wound Care Project Manager at Aging, Rehabilitation and Geriatric Research Center of Lawson Health Care Research Institute, St Joseph’s Health Care London.

She has co-lead the development of Canadian Best Practice Guidelines for Pressure Ulcer prevention and treatment in the spinal cord injured individual. She has played a role in the development or revision of all 4 RNAO Best Practice Guidelines for Wound Healing; she has published several articles and book chapters on wound healing, and has been an active presenter and many wound care conferences.

Professor Keryln Carville RN, STN(Cred), PhD

Professor Primary Health Care & Community NursingSilver Chain & Curtin University, Western Australia.

Keryln is Chair of the Australian Pressure Injury Advisory Panel that resulted in the development of the Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury (2012). She is Chair of the Pan Pacific Pressure Injury Alliance which is partnering with EPUAP and NPUAP for the review and updating of their 2009 guideline. Chair of the AWMA Australian Wound Standards Committee and Chair Evidence Committee International Wound Infection Institute. She sits on the Editorial Boards of Wound Practice & Research and the Journal of Stomal Therapy Australia. She was awarded the WA Health Life Time Achievement Award for Nursing in 2010. Keryln is a participant in the Wound Innovation CRC Program at Curtin and Silver Chain and the focus of their research is skin tears and surgical wound dehiscence.

Keryln was appointed an Inaugural Fellow of the Australian Wound Management Association in 2006.

Associate Professor Andrew Jull RN PhD

Andrew Jull is a registered nurse and clinical epidemiologist, an Associate Professor in the School of Nursing and Senior Research Fellow at the National Institute for Health Innovation at the University of Auckland. He is also Nurse Advisor, Quality and Safety, Auckland District Health Board. Andrew is a member of the First Do No Harm steering group, leads a pressure injury improvement project at Auckland District Health Board, and has had extensive involvement in the effectiveness movement including teaching, research, and guideline development. He is a past editor of Evidence Based Nursing and editorial advisory board member of BMJ. He is a current editor for the Cochrane Wounds Review Group and editorial advisory board member for the International Journal of Nursing Studies and the Journal of Wound Care.

skin Integrity Forum

6.

Debra had the pleasure of opening the Skin Integrity forum with her presentation. Her presentation was a perfect introduction to the Forum as she started by presenting on the physiology and functions of the skin.

As we know skin is a vital organ which performs a number of critical functions and most importantly it protects internal structures from exposure to the environment which can contribute to dehydration and injury. A complex network of nerves, in combination with hair follicles releases or conserves heat to provide temperature regulation. Sensory nerves provide essential information about the environment and cells in the epidermis also perform important immune functions.

Debra takes an in-depth look at the skin and scientifically details the functions of each layer. She also discusses the impact of aging on the skin and how the epidermal – dermal junction thinning of the skin can cause a loss of the anchoring mechanism between the dermis and epidermis and a decrease in collagen and elastin can cause increased risk in shearing forces and adhesive trauma causing skin injury. Furthermore, Deb discusses how a reduction in perfusion, a reduced immune response and a reduction in the response to growth factors can lead to a slowed barrier recovery and potential for prolonged healing. Additionally the following issues can arise: friction injury, pressure injuries, irritant contact dermatitis, Moisture Associated Skin Damage.

Through her presentation, Deb identifies how “moisture lesions“, a type of moisture associated skin damage, are often misdiagnosed as pressures injuries when the underlying cause is actually the interaction of friction and moisture. Debra reviews the complexity of Moisture Associated Skin Damage and Incontinence Associated Dermatitis (IAD).

With the knowledge of the physiology and functions of the skin and understanding the problems that can arise, Deb concludes her

Introduction to skin Integrity - deb Thayer

presentation reviewing best practice for skin care. She explores the question of what we are trying to accomplish when it comes to skin care and identifies four areas of focus: 1) cleansing 2) moisturising 3) protection 4) treatment.

Deb helps us to look at the current trends in cleansing - the use of liquid cleansers, basin – free bathing and CHG bathing. CHG bathing is aimed at the prevention of Catheter Related Blood Stream Infections not skin integrity however skin care for the purposes of maintaining skin integrity needs to be compatible with CHG due to the increasing use of CHG products for cleansing.

With trends in moisturisation there is increasing recognition to maintain the stratum cornium and use of moisturisers as a preventative strategy is increasing and Deb reviews the ingredients often present in common moisturisers.

When we look at the trends in skin protection there is the increasing recognition in the literature of the limitation of zinc oxide and petrolatum and the increasing trend toward using products that contain silicone polymers and propriety polymers. Also in clinical practice there is an expanded use of alcohol free barrier films as they are able to be used on damaged or broken skin.

In summary Deb reflects on how times have changed and health care professionals are no longer accepting noso-comial skin damage. Skin damage has become a patient safety issue, primarily this has related to pressure injuries however increasingly health care professionals are now implementing strategies to prevent other skin damage related injuries such as moisture damage and adhesive trauma. This is leading to recognition of skin care as a strategic intervention and prevention strategy. The status quo is no longer acceptable.

did you know?

Skin damage constitutes a negative clinical outcome and a poor patient experience

Best Practice statement. care of the older Person’s skin. London: Wounds uK, 2012 (second edition).doughty d, junkin j, Kurz P, selekof j, Gray M, Fader M, Bliss dZ, Beeckman d, Logan s Incontinence-Associated dermatitis: consensus statements, evidence-Based, Guidelines for Prevention and Treatment, and current challenges. j Wound ostomy continence nurse. 2012;39(3):303-315.Bliss, d.Z, Zehrer, c.L, savik, K, smith, G & Hedblom, e. (2007). An economic evaluation of Four skin damage Prevention regimens in nursing Home residents with Incontinence. journal of Wound ostomy & continence nursing. 34 (2): 143 – 152.

To listen to Deb’s 30 minute presentation, please click on the link below:

http://brightcove04.brightcove.com/23/1242911116001/201311/1435/1242911116001_2871706464001_SIF--1---Debra-Thayer.mp4

7.

ISSUE 5, November 2013

We were very privileged to have an international speaker of Karen’s calibre at the Skin Integrity Forum. Dr Karen Campbell is from Canada and she gave a fantastic presentation that really set the scene for the issues associated with IAD and its consequential impact.

Dr Campbell begins with these issues and questions why is IAD so important. She concludes that it is prevalent and has a genuine significant negative impact on patients. Research shows us that IAD can be prevented and treated and so ethically we are not in a position to ignore this problem any longer.

For many years clinicians have had difficulty differentiating between IAD and pressure injuries. The North American Pressure Ulcer Advisory Panel (NPUAP) and the European Pressure Ulcer Advisory Panel (EPUAP) have stated that IAD is not a pressure injury and the etiology of IAD is very different to the etiology of pressure injuries. We need to treat the cause therefore the treatment is different.

A definition of IAD is provided by Dr Campbell and she discusses how skin damage is dependent upon the irritant (e.g. from urine to liquid stool); duration of exposure; and frequency of exposure.

The epidemiology of IAD is explored with studies presented around frequency of IAD with faecal incontinence, IAD and urinary incontinence in a long term acute care setting and IAD in the critically ill. Dr Campbell examines a study that looked at time to develop, severity and risk factors of IAD. Prevalence of IAD is also reported upon.

It is important to understand the differential diagnosis of IAD and Pressure Injuries (PI). Differentiating factors to consider include: 1) location 2) associated factors that would cause a pressure injury versus IAD 3) depth 4) shape and 5) distribution. Associated findings are also key and examples of this are that with a pressure injury necrosis is present as well as undermining or tunneling. We need to remember that a pressure injury is a bottom up injury and IAD is a top down injury where you see the surrounding skin more macerated. We are cautioned however that you can have both PI and IAD present at the same time.

Cost effectiveness of prevention and treatment of IAD is explored in Dr Campbell’s presentation through studies exploring the implementation of both product, education and consulting programmes and quality improvement initiatives. Several studies also reported cost of soap and water versus pH balanced no rinse cleansers showing results in a significant reduction in staff time and labour costs with the combined reduction in the incidence of IAD.

Dr Campbell presents a study with the use of 3M™ Cavilon™ No Sting Barrier Film applied three times weekly and compared to zinc

The Impact of Incontinence Associated dermatitis (IAd)- dr Karen campbell

and petrolatum and cleansing after each incontinence episode. 3M™ Cavilon™ No Sting Barrier Film was found it to be as clinically effective and more cost effective. Two further studies that Dr Campbell presented at the SAWC Conference in the US are explored. Firstly a study to evaluate the skin pre and post use of 3M™ Cavilon™ Durable Barrier Cream as a moisturiser, barrier and combination and to determine the number of days till improvement with 47 patients on a geriatric unit. The second study evaluated 3M™ Cavilon™ No Sting Barrier Film to determine if it reduced redness due to urinary and faecal incontinence prevented or reduced maceration, prevented or reduced skin stripping or whether any adverse effects were experience by patients.

Finally evidence based practices for the prevention and management of IAD is reviewed through the 2012, Incontinence Associated Dermatitis: Consensus Statements, Evidence Based Guidelines for Prevention and Treatment and Current Challenges. (Doughty D, Junkin J, Kurz, P, Selekof, J, Gray M, Fader, M, Bliss, D Z, Beekman, D,& Logan Journal of Wound, Ostomy and Continence (2012): 39(3): 303 – 315)

Dr Campbell describes the levels of evidence and how these are defined in terms of level A, B and C evidence. First and foremost the most important recommendation is to have a consistently applied, defined, or structured skin care regimen for prevention and treatment of IAD (Level of Evidence A). Key recommendations from the document include the selection and use of skin care products used for IAD and Dr Campbell summarises with the need for additional research to establish a benchmark for measuring various skin protectants’ ability to block exposure to a specific irritant. In the same way that we are undertaking more work relating to pressure injuries, we need the same type of work to be done with skin care products for IAD prevention and management.

IAD consensus recommendations supporting interventions for prevention and treatment of IAD are also discussed by Dr Campbell in relation to absorptive containment products, diverting urine and stool with the appropriate use and rationale for using indwelling urinary and faecal diversion systems. Referral to a continence specialist should be considered for assessment and treatment of the underlying incontinence – incontinence can often be treated and should be the priority.

The summary from the presentation is that:

• IAD is a common and preventable condition

• Consensus statements have been developed by experts to be used

• Prevention and treatment protocols are less costly and more effective than standard care

• Unrecognised and untreated IAD results in pain and suffering and reduced quality of life

To listen to Dr Karen Campbell’s 55 minute presentation, please click on the link below:http://brightcove04.brightcove.com/23/1242911116001/201311/269/1242911116001_2871609641001_SIF--2---Dr--Karen-Campbell--1-.mp4

8.

As always Professor Keryln Carville gave an engaging and insightful presentation. Her presentation was packed full of information to take back into the clinical environment in relation to the Pan Pacific Guideline for the Prevention and Management of Pressure Injury and the National Safety and Quality Health Service Standards - Standard 8: Reducing Pressure Injuries.

Professor Carville set the scene by exploring the scope of the problem across the globe and raises the question: how can we benchmark when we don’t use the same methodology for collecting our data? In Australia we potentially have the best data available due to work conducted by Dr Jenny Prentice who demonstrated the benefits of skin inspections undertaken by two surveyors and the testing for inter-reliability prior to conducting prevalence surveys.

Cost is a great stimulus for many of the things we do in health care and one year’s data from ICD10 in one jurisdiction reported there was 2,783 pressure injuries with an additional cost of US$24,234,740 to the health care system. In this instance pressure injuries were the 5th most preventable condition which begs the question as to how much we spend on treatment of pressure injuries versus whether or not it could be money better spent on prevention!

Continuing to explore the influence of cost, in Queensland they have adopted a penalty for pressure injuries. Professor Carville posed the question as to whether this is the way to go in light of Japanese findings that a financial reward system for hospitals rather than a penalty proved more beneficial for reducing pressure injury prevalence. Litigation was also discussed as an influencing factor.

Professor Carville discussed how pressure injuries can have a significant impact on an individual’s wellbeing and their physical, social, spiritual and mental health.

The Australian Wound Management Association (AWMA) was privileged

Pressure Injury Prevention strategies - Professor Keryln carville

to partner with Hong Kong Enterostomal Therapists Association, Wound Healing Society of Singapore and with the New Zealand Wound Care Society in the development of the Pan Pacific Clinical Practice Guidelines for Prevention and Management of Pressure Injuries Guideline (2012).

The Guideline used Level 1 evidence and focuses on prevention, assessment and management of pressure injuries. The Guideline is freely available to all health care providers and clinicians, carers, consumers across the Pan Pacific Region and can be downloaded from www.awma.com.au.

One of the obvious key changes in the new guideline was with the adopted NPUAP (2009) definition and a change in terminology from ulcer to injury. The principles and over – ridding aims of the Guideline are to: 1) prevent pressure injuries; 2) indentify patients at risk of pressure injuries; 3) encourage risk assessment of pressure injuries; 4) optimise management of pressure injuries.

In Professor Carville’s presentation she outlined the key Guideline points with specific mention to the recommendation NPUAP and EPUAP (2009) staging; focus on pressure injury risk; risk assessment and prevention strategies.

Professor Carville explained the differences and changes as per the previous definitions used by AWMA and the two additions to the staging system being unstageable and suspected deep tissue injury.

Professor Carville concluded her presentation with an overview of the National Safety and Quality Health Service Standard 8. The aim of Standard 8 is to reduce the incidence of pressure injuries and apply best practice in their management. The Pan Pacific Clinical Guideline summarises the evidence and health care services and clinicians need to demonstrate that they systematically identify and respond to pressure injury risk. There are four criteria within the Standard 8 and they are: governance and systems, preventing pressure injuries, management of pressure injuries and communication with patients and carers.

did you know? Maklebust, j & Magnan, M. (1994). risk Factors Associated with having a Pressure

ulcer. A secondary data Analysis. Advances in Wound care. 7(6): 25 – 42.

Patients with faecal incontinence are 22x more likely to develop a Pressure Injury

To listen to Professor Keryln Carville's 35 minute presentation, please click on the link below:http://brightcove04.brightcove.com/23/1242911116001/201311/2379/1242911116001_2871343002001_SIF--3---Prof--Keryln-Carville.mp4

9.

ISSUE 5, November 2013

Associate Professor Jull begins his presentation by introducing the audience to the First Do No Harm (FDNH) Initiative. The FDNH initiative has adopted a campaign methodology to create energy and momentum to make patient safety a top priority and to shift the mindset to a focus on achieving no avoidable harm. Clinically-led, reducing harm from pressure injuries is one of these key initiatives with the strategic aim to reduce pressure injuries by 20%.

FDNH is an initiative driven from the New Zealand Government requiring District Health Boards (DHBs) to plan together. DHBs in the Northern Regional Health Plan include Northland DHB, Auckland DHB, Waitamata DHB and Counties Manukau. Together these DHB’s provide public health services to approximately 1.8 million people including 3000 acute beds and 11,000 aged residential care beds.

Associate Professor Jull is a member of the FDNH group and leads the pressure injury improvement project at Auckland District Health Board. In this presentation Associate Professor Jull discusses the work that is being done by the regional team. The regional team focused firstly on hospital acquired pressure injuries however it is was recognised that the issue was not just a hospital problem and that work was also needed to support the aged residential care sector.

Measurement of prevalence was a starting point for the initiative and this involved an audit of five randomly selected patients per ward. The EPUAP audit tool was utilised and measurement conducted one day a month. Agreement was made to include all grades of pressure injuries in the prevalence report and the results were then shared with the FDNH group.

The next step were to utilise an IHI collaborative approach which included three learning sessions, with each learning session separated by several months. These sessions bring teams from the DHBs and aged care facilities together, to share and learn from each other using story boards and presentations. These sessions were also used to plan activities and they also lead to building a wider community of improvement activity. Not everyone could attend these sessions so mini learning sessions were held in between the main learning sessions to capture a larger range of people.

Associate Professor Jull describes the FDNH initiative as a bunch

Learning from a regional collaborative in new Zealand to reduce Pressure Injury - Associate Professor Andrew jull

of people who want to do better. They share their resources, offer learning’s to each other and pool their knowledge.

To conclude his presentation, Associate Professor Jull shares what has been achieved since January 2013 – a reduction in the number of all grades of pressure injuries to a total prevalence of approximately 3.5% in March 2013. Average prevalence of Grade 3 and Grade 4 pressure injuries is less than half a percent and from January 2013 to May 2013 no Grade 3 or Grade 4 hospital acquired pressure injuries have been recorded.

This leads Associate Professor Jull to highlight what is working for FDNH - he attributes the success to a collaborative approach and the increased focus on pressure injuries! Also going out on a limb and creating evidence while practising. An example of this was some feedback that was received from staff at Auckland DHB outlined a lack of time to be able to do a full risk assessment on all patients. This led to looking for a quick screening tool however one did not exist. A new four question tool was created that is now part of the adult observation chart.

The questions included: 1) does the patient have an existing pressure injury? 2) does the patient need assistance to change position in bed? 3) is the patient incontinent? 4) has the patient had recent weight loss or difficulty eating? If the answer yes to any one of the four questions, staff are required to complete a full assessment and the Waterlow Pressure Injury Assessment tool is used.

In summary, Associate Professor Jull ends his excellent presentation with: ‘the reality is we need to be both snails and evangelists for improvement as we have to make decisions despite imperfect information. So we use strong evidence where it exists. At Auckland DHB we have high specification foam mattresses on all hospital beds, we have risk assessment, we having turning schedules, we have access to alternating pressure mattresses, but we are also trying other innovations that may have an impact on pressure injuries. Quick risk screening for full risk assessment is one, intentional rounding is another. It is not enough to be a snail or an evangelist, we must be both that is if we want to stop pressure injuries’.

At First Do No Harm, WE DO.

To listen to Associate Professor Andrew Jull’s 15 minute presentation, please click on the link below:http://brightcove04.brightcove.com/23/1242911116001/201311/3549/1242911116001_2871004743001_SIF--4---Assoc--Prof--Andrew-Jull.mp4

10.

Jill Campbell presented a fascinating picture of IAD in particular relation to the acute care setting and some landmark data from her Australian study.

Jill commences the presentation by defining prevalence and incidence as often there is confusion around these words and they are often used interchangeably. Prevalence is the count of cases of a condition or disease among a defined population – it looks at a specific time but doesn’t tell us how long a condition has been present. Incidence (or incidence rate) is the number of new cases of a disease that develop during a time period in a population that is at risk.

Until recently the majority of IAD data came from the aged care setting and we cannot generalise the data from acute care to aged care. A significant study in the US is reported on which looks at incontinence prevalence in acute care and of that incontinent group the prevalence of IAD, fungal infection, pressure injury and perineal skin injury.

Jill presents data from a study which she lead which explores the prevalence of IAD in an Australian acute care hospital through an observational point prevalence design.

Reporting IAD is discussed and how we can address this - perhaps an answer would be to conduct pressure injury and IAD audits together as part of our routine skin injury quality activities. We need to raise the awareness of IAD through our documentation in relation to assessment, interventions in terms of prevention and management, and incident reporting for ongoing care planning. Documentation needs to become part of the handover and how we communicate on continence, skin status, pressure injury and IAD. We also need to ask our patients about their continence and listen to what they are saying, not just put a pad on.

Finally Jill talks about a concept called “Skin Safety” and look at all iatrogenic skin injuries and discusses the fact that it’s everyone’s responsibility. Let’s ensure incontinence and IAD are not the elephant in the room.

IAd Prevalence in the Acute care setting - jill campbell

To listen to Jill Campbell’s 25 minute presentation, please click on the link below:http://brightcove04.brightcove.com/23/1242911116001/201311/3581/1242911116001_2871369311001_SIF--5---Jill-Campbell.mp4

did you know?

Peterson, K.j, Bliss, d.Z, nelson, c & savik, K. (2006). Practices of nurses and nursing Assistants in Preventing Incontinence – Associated dermatitis in Acutely / critically Ill Patients. American journal of critical care. (Abstract). 15(3): 325).

Up to 95% of incontinent patients in ICU were found to have Incontinence Associated Dermatitis (IAD)

11.

ISSUE 5, November 2013

IAd and Pressure Injury strategies in Intensive care- Associate Professor Fiona coyerAssociate Professor Fiona Coyer gave a fantastic and thought provoking presentation around her research into Incontinence Associated Dermatitis (IAD) and pressure injury strategies in the Intensive Care Unit (ICU). This was in relation to the Inspire Study and research exploring device related injuries and conclusions from the data gave some excellent key practice points to consider.

Intensive Care is a unique practice environment where the patient is under unique physiological challenges. Skin Integrity is threatened with critical illness due to pathopysiological reasons, biophysical threats and pharmological threats. It is a complex phenomenon. Key risk factors to skin integrity include pressure, shear, friction (e.g. dry skin) and moisture (e.g. faecal incontinence).

There is minimum prevalence data on IAD in the ICU and prior to the Inspire Study there was none available in Australia. The Inspire Study had a two part focus with the first part addressing IAD and the second pressure injuries in the ICU setting over a one year timeframe.

In part one exploring IAD, the intervention group (105 patients) was compared to a control group (102 patients) receiving standard care. Intervention included skin examination and assessment within four hours of admission; continued examination of the skin every 12 hours; daily bed bath – using pre packaged wash cloths with Chlorhexidine Gluconate, moisturiser to dry skin and 3M™ Cavilon™ No Sting Barrier Spray as a preventative measure applied to every patients buttock and perineal area after their daily bed bath.

Results showed that IAD reduced from 21% to 12% and time to event occurring was reduced as well. The results, although not statistically significant were clinically significant with the mean time to develop IAD decreasing from 7 days to 5 days in the control group.

The second part of the Inspire Study looked at pressure injuries in the ICU, having the same study design and number of patients as the first. Intervention for reducing pressure injuries was again skin examination and assessment within four hours of admission as well as accurate documentation; bed bath daily using pre – packaged wash cloths with 2% Chlorhexidine Gluconate and they were warmed in blood warming fridge; moisturiser applied to dry skin and repositioning 3 hourly with a turn clock to fit in with units care practices. It also included securing and repositioning of therapeutic devices inline with the existing endo – tracheal (ET) tubes and naso - gastric (NG) tube policy and protocol identifying that they should be re – positioned once per shift.

The results demonstrated a reduction of pressure injury prevalence across all stages of pressure injury from 30% to 18% - which was statistically significant. The results also measured the number of ulcers. Mucosal Ulcers were of most interest and were reduced from 39 to 15 showing statistical significance.

The final part of the presentation looked in more detail in mucosal pressure injuries, which are often from NG and ET Tubes. A multi-centred (US and Australia), cross sectional data looked at prevalence of medical device related pressure injuries and interventional strategies to reduce prevalence.

Conclusion from all the data presented included:

• Being ever alert to threats to skin integrity in this very vulnerable and unique environment and patient population

• Rather than guidelines and protocols – suggest a bundle approach; that we do it or we don’t – and have a check list

• Assess patient skin especially in critical care in a very short time frame from admission

• Reposition our ICU patients very regularly and on an individual basis

• Consider preventative measure for those devices that we insert invasively and we can know we can prevent injury as a result of repositioning, constant padding and vigilance

To listen to Associate Professor Fiona Coyer’s 25 minute presentation, please click on the link below:http://brightcove04.brightcove.com/23/1242911116001/201311/2587/1242911116001_2870820540001_SIF--6---Assoc--Prof--Fiona-Coyer.mp4

12.

Part 2: Implementing a skin care Programme

In this very insightful presentation Dr Campbell talks about her experiences in implementing a skin care best practice programme and she details how we can apply the principles of knowledge transfer to make change happen.

A specific skin care programme was introduced when Dr Campbell was working as a Continence and Wound Care Advanced Practice Nurse in Ontario, Canada in a 600 bed hospital focussed on palliative and rehabilitation care. There were no wound care programmes in place however there was an urgent need for them. The first six months was spent developing wound care champions and providing them with education so they could be local experts in their individual units.

Once the wound care programme was underway the focus shifted to prevention rather than the previous reactive model. Dr Campbell applied her geriatric background and looked at wound care and pressure injuries in a multi – factorial and an inter– professional approach to care. Her aim was to treat all patients the same way, have a universal approach and provide excellent skin care for all.

Dr Campbell details the many reasons as to why a change was necessary, including the pressure injury prevalence at that time, no standardised approach to care and overall the patients were not receiving best practice.

The barriers to implementing the skin care programme included: patient and families who wanted to use the skin care products they liked; and nurses did not want to change practice and management who were worried about how much this was going to cost and who was going to pay for it. Purchasing had never worked with clinicians. However, families were the biggest barrier.

The strategies that Dr Campbell developed was to attend family meetings and educating them about proposed change and to present the advantages for their family member to the family and to involve the family as much as possible in the care. The nursing staff were also educated on the purpose of the project and particular attention was paid to answering their questions and listening to their concerns, such as concerns nursing staff had around the time required to implement and undertake the new skin care programme. The key to engaging management was to get the most senior administration support first and to get their support with education and financial aspects of the change.

The wound care committee, (made up of the champions) was crucial with the process of implementation. It was decided that the programme needed to be simple with a skin friendly model, but also with a high level

Implementing a skin care Program - dr Karen campbell

of skin science. Products were evaluated considering: sensitisers, pH levels, ingredients as well as ease of use for nurses and satisfaction of the patients and their families. The final decision was made by the nurses and the skin care products that were chosen was an incontinent and skin care cleanser, a moisturiser and a barrier for the peri - wound and perineum.

The outcome after implementation of multiple prevention interventions resulted in reduction in pressure injury prevalence of 30% to 5% and a significant reduction in Incontinence Associated Dermatitis (IAD).

Dr Campbell discusses her key learnings and what she would do if she had to do it again with the current situation. She would use the RNAO (Registered Nurses Association of Ontario) Toolkit for Implementation of best practice. The toolkit is based on knowledge to action and makes good clinical sense. The key principles being:

• Identification of the problem

• Exploring consensus documents / guidelines – is there is anything to help with the problem?

• Do I need to adapt the knowledge to the local content?

• Identify and start working with your stakeholders (e.g. senior administration etc) and have a plan

• What resources do I need? Need to identify resources in business plan and cost it out. In prevention you can show the cost and time saved. Link to a quality initiatives and patent safety programmes.

• What / who are the barriers and facilitators – use the facilitators to overcome the barriers!

• Select, tailor and implement your intervention strategies

• Monitor if knowledge is being implemented – do audits and go out into the floor to see what is being done and reward the staff

• Evaluate patient outcomes and key indicators

Finally Dr Campbell discusses the all important question of sustainability and how do you sustain the momentum? She concludes that it is dependent on supportive leadership, facilitative human resources and ongoing staff education through orientation and professional development programmes. It also includes be able to adapt and integrate new knowledge into the ever changing and evolving practice environments. Policies and procedures or a protocol (whatever the terms is relevant for you organisation) for Incontinence Associated Dermatitis (IAD) prevention and management need to be in place and this needs to be part of orientation and refresher programmes.

To listen to Dr Karen Campbell’s 55 minute presentation, please click on the link below:http://brightcove04.brightcove.com/23/1242911116001/201311/305/1242911116001_2864235493001_SIF--7---Dr--Karen-Campbell--2-.mp4

In addition to the presentations, a 40 minute question and answer panel discussion session was held at the Skin Integrity Forum. To listen to this session, please click on the link below:http://brightcove04.brightcove.com/23/1242911116001/201311/2543/1242911116001_2864153161001_SIF--8---Panelist-Discussion.mp4

13.

ISSUE 5, November 2013

WORLD WIDE

STOPPRESSURE ULCER DAY

November 21 2013

www.epuap.org

1. IS YOUR PATIENT AT RISK?• Conduct a comprehensive risk assessment on admission• Use a validated pressure ulcer risk assessment tool• Conduct a complete skin assessment• Undertake nutritional screening

2. IMPLEMENT PREVENTATIVE STRATEGIES• Reposition regularly • Use suitable transfer aids• Use a high quality foam mattress for all at risk• Use an active support surface for patients at higher risk• Protect the skin• Consider high protein oral nutritional supplements• Inform and educate your patient where possible• Continue to risk assess and evaluate interventions

3. DOCUMENT ALL...Assessments, management plans and interventions

Pressure ulcers are a major burden to patients, their carers and society

STOP!PREVENTING PRESSURE ULCERS(Also known as bedsores, pressure injuries & pressure areas)

www.epuap.orgAll content was created by the EPUAP and printed

under an unrestricted educational grant from

PRESSURE ULCERS ARE PREVENTABLE ADVERSE EVENTS

European Pressure Ulcer Advisory Panel

14.

Does Incontinence Associated Dermatitis

(IAD) ever get misreported as a pressure injury?

15.

ISSUE 5, November 2013

The assessment of IAD, including risk assessment and differentiation from other forms of skin damage such as pressure injuries or skin tears, remains a challenge for both expert and non - speciality nurses.* The most clinically relevant argument for differentiating IAD versus pressure injury is the impact of accurate prevention and treatment.*

* Gray, M. Beeckman, D. Bliss, D. Fader, M, Logan, S. Junkin, J. Selekof, J & Doughty, D. (2012) Incontinence Associated Dermatitis: A Comprehensive Review and Update. Journal of Wound, Ostomy & Continence Nursing. 39 (1): 1 - 14

Moisture Lesions vs Pressure InjuriesDifferentiation Between Pressure Injuries and Moisture Lesions

www.epuap.orgDefloor T., et al, Differentiation between Pressure Injuries and moisture lesions, European Pressure injuries Advisory Panel Reviews, Volume 6, Issue 3, 2005

Moi

stur

e Le

sion

sM

oist

ure

Lesi

ons

Moi

stur

e Le

sion

s

Moi

stur

e Le

sion

sM

oist

ure

Lesi

ons

Moi

stur

e Le

sion

s

Pres

sure

Inju

ries

Pres

sure

Inju

ries

Pres

sure

Inju

ries

Pres

sure

Inju

ries

Pres

sure

Inju

ries

Pres

sure

Inju

ries

Location

Shape

Depth

Necrosis

Edges

Colour

A combination of moisture and friction may cause moisture lesions in skin folds, but most commonly they are present in the anal cleft.

Diffuse, different superficial spots are more likely to be moisture lesions. In a kissing ulcer (copy lesion) at least one of the wounds is most likely caused by moisture.

Moisture lesions are superficial (partial thickness skin loss). In cases where the moisture lesion gets infected, the depth and extent of the lesion can be enlarged.

There is no necrosis in a

moisture lesion.

Moisture lesions often have

diffuse or irregular edges.

If redness is not uniformly

distributed, the lesion is likely to

be a moisture lesion.

A pressure injury is most likely to

occur over a bony prominence.

Circular wounds or wounds with

a regular shape are most likely

Pressure Injuries, however, the

possibility of friction injury has to

be excluded.

Pressure Injuries vary in depth

depending on classification.

A black necrotic scab on a bony

prominence is a pressure injuries

classification 3 or 4.

If the edges are distinct, the

lesion is most likely to be a

pressure injury.

If redness is non-blanchable, this is most likely a pressure injuries. For people with darkly pigmented skin, persistent redness may manifest as blue or purple.

16.

How do you prevent and manage

Incontinence Associated Dermatitis (IAD)?

17.

ISSUE 5, November 2013

Prevention Makes sense

Create and Implement an Effective Skin Damage Prevention Protocol with 3M™ Cavilon™ Professional Skin Care ProductsClinical evidence supports the use of a defined skin care programme and quality products. Adherence to a defined and consistent skin care regime will maintain or restore the inherent skin barrier of patients3,4. A study completed by Bale et al, 20045, evaluated the effect of a skin care protocol on patient skin condition, staff time and associated costs in a nursing home.

The skin care protocol consisted of 3M™ Cavilon™ No Sting Barrier Film on patients with moderate or severe Incontinence Associated Dermatitis (IAD), and a dimethicone-based barrier cream (3M™ Cavilon™ Durable Barrier Cream) on patients with intact skin/mild Incontinence Associated Dermatitis (IAD).

The key findings showed skin condition was maintained or improved and there was a significantly lower incidence of incontinence dermatitis after introducing the skin care protocol. There was also a significant reduction in time to deliver the skin care post-intervention. Staff adherence to the new skin care protocol was good. This study demonstrated that the new skin care protocol with an educational program maintained or improved patients’ skin condition and significantly reduced the resources used in delivering nursing care.

1. Bliss, D.Z, Savik, K, Thorson, M.A.L, Ehman, S.J, Lebak, K & Beilman, G. (2011). Incontinence – Associated Dermatitis in Critically Ill Adults: Time to Develop, Severity and Risk Factors. Journal of Wound Ostomy & Continence Nursing. 38(4):433 – 4452. Gray, M, Beeckman, D, Bliss, D.Z, Fader, M, Logan, S, Junkin, J, Selekof, J & Doughty, D. (2012) Incontinence – Associated Dermatitis: A Comprehensive Review and Update. Journal of Wound Ostomy & Continence Nursing. 39(1): 1 – 143. Doughty D, Junkin J, Kurz P, Selekof J, Gray M, Fader M, Bliss DZ, Beeckman D, Logan S Incontinence-Associated Dermatitis: Consensus Statements, Evidence-Based Guidelines for Prevention and Treatment, and Current Challenges. J Wound Ostomy Continence Nurse. 2012;39(3):303-315.4. Black et al, 2012. MASD Part 2: Incontinence – Associated Dermatitis and Intertriginous Dermatitis: A Consensus. Journal of Wound, Ostomy and Continence Nursing5. Bale S, Tebble N, Jones VJ, Price PE. The benefits of introducing a new skin care protocol in patients cared for in nursing homes.(2004) J Tissue Viability 14(2): 44–50.

Incontinence Protocol

1 to 3episodes of urinary and/or faecal incontinence a day

4 +episodes of urinary and/or faecal incontinence a day

Intact Skin Broken Skin Intact Skin Broken Skin

skin intact with/without erythema

skin with severe erythema or erosion

skin intact with/without erythema

skin with severe erythema or erosion

Apply 24 Hourly Apply 12 - 24 Hours Apply 8 - 24 Hours Apply 12 - 24 Hours

early monitoring and prevention of IAd, especially in patients with diminished cognition or with frequent leakage of loose or liquid faeces, are recommended to promote skin health1.

Assess for IAd risk when performing your pressure injury risk assessment.

A consistently applied, defined, or structured skin care regimen is recommended for prevention and treatment of IAd2.

18.

Introducing 3M’s rIse Program The RISE (Reducing the Incidence of Skin Breakdown through Education) Program is an educational program which 3M can offer to clinicians to help to reduce the incidence of and the cost associated with skin breakdown and to help you with your pressure injury and IAD prevention programs.

The RISE program offers a range of tools and support including:

Clinically Proven ProductsThe 3M™ Cavilon™ Professional Skin Protection Range was designed to help provide simple, soothing relief for vulnerable skin and assist you to simplify your patients skin care regimen, maintain support for skin integrity and provide cost effective treatment options. All our Cavilon products are supported by extensive research and clinical evidence so you can be assured that you are providing exceptional patient comfort and care.

Please note the Cavilon No Sting Barrier Film 3ml Wand is not available in New Zealand.

RISE Newsletters3M produces these RISE Newsletters twice yearly with a different focus each edition e.g.: incontinence, adhesive trauma, stoma care and management.

PREVENT

INTERVENE

Skin Intact

with/without erythema

Skin with severe

erythema or erosion

Skin Intact

with/without erythema

Skin with severe

erythema or erosion

24 Hourly

8-24

Hours

12-24

Hours

12-24

Hours

1 to 3 episodes of urinary and / or faecal

incontinence / day

4 or greater episodes of urinary and / or faecal

incontinence / day

3M™ Cavilon™ Skin Protection Range

Incontinence Algorithm

PB5470/1212

Helping you RISE to the Challenge

3M Australia Pty Limited

3M Medical

ABN 90 000 100 096

Building A, 1 Rivett Rd

North Ryde, NSW 2113

1300 363 878

www.3M.com.au

3M New Zealand Limited

94 Apollo Drive,

Rosedale

Auckland 0632,

New Zealand

www.3m.co.nz

Incontinence Algorithm Incontinence Protocol for Critical CareIncontinence Protocol

Clinical ProtocolsAs part of the RISE Program, 3M offers clinical protocols for incontinence to assist with product use and re-application to ensure the most cost effective use of products and to encourage best practice outcomes for your patients. Our qualified Clinical Specialists can assist your organisation in the development of protocols to suit your specific needs within your organisation.

Don’t forget to email us if you’re not on our subscription list.

Email Kelly Banks on kbanks@mmm.com

to subscribe.

19.

ISSUE 5, November 2013

Educational SupportFor PatientsPatient information is available on the general principle of skin care to help you educate and support patients.

For Healthcare Professionals3M Territory Managers and our Clinical Specialists in Skin Integrity can help your facility to determine best practice and cost effective treatment options which will assist you in your healthcare practice. They can also provide product in-servicing and ongoing education for your staff to ensure appropriate product usage and application.

educational resources3M has a multitude of different resources available to help support your pressure injury prevention program; to help prevent skin breakdown; and to help you to implement a personalised Incontinence Protocol into your organisation or facility.

• Healingpotentialissignificantlycompromisedinthecritically

illandskindamagehasthepotentialtocreateserious

consequencessuchasinfection1

• Evenminorskininjurycancreatediscomfortandpainand

addtopatientsuffering2,3,4

• Skindamageconstitutesanegativeclinicaloutcomeanda

poorpatientexperience2

• Strengthenyourpressureinjurypreventionprogramand

avoidcostsassociatedwithskindamage

Incontinence Skin Care Solutions in Critical Care

fromthe3M™Cavilon™ProfessionalSkinProtectionRange

inCriticalCareSkinBreakdownPreventing

Cavilon™

Incontinence Skin Care Solutions in Aged Carefrom the 3M™ Cavilon™ Professional Skin Protection Range

Cavilon™

for Incontinence

Skin Care• The effects of incontinence on the skin are known to be a significant cause of skin damage1• Aging skin is particularity at risk1

• Even minor skin injury can create discomfort and pain and add to patient suffering1,2,3• Skin damage constitutes a negative clinical outcome and a poor patient experience1•Strengthen your pressure injury prevention program and avoid costs associated with skin damage

Incontinence Skin Care Solutions for Critical Care Booklet

Incontinence Skin Care Solutions for Aged Care Booklet

RISE Educational Workshops & Webinars3M hosts accredited educational workshops and live webinars to provide continuing education on Skin Integrity, Incontinence Associated Dermatitis (IAD) and pressure injuries. 3M’s webinars and workshops are led by recognised local and international experts and are available on request for conference and other large group situations.

For more informationThese products, resources and education resources and events can be accessed through your local Critical & Chronic Care Solutions Division Territory Manager. If you have any questions or require further information, please contact our Customer Care Helpline on 0800 80 81 82 (in NZ) or 1300 363 878 (in Australia) to be put in contact with your local Territory Manager.

20.

Purple for Prevention3M Cavilon Durable Barrier Cream

Blue for Broken3M Cavilon No Sting Barrier Film

3M™ Cavilon™ Durable Barrier Cream 3M™ Cavilon™ No Sting Barrier Film are versatile and meet multiple skin protection needs.

Friction from oxygen masks and tubing

Adhesive trauma from feeding tubes

Maceration around tracheostomy tubes

Adhesive trauma at infusion sites (central)

Friction over heels and elbows

Skin damage around surgical incisions

Adhesive trauma associated with negative pressure wound therapy (NPWT)

Peristomal skin damage

Adhesive trauma from condom catheters

Incontinence Associated Dermatitis (IAD)

Friction from prosthesis

Adhesive trauma at infusion sites (peripheral)

Dribbling

Skin folds

Incontinence protection

Moisturising fragile dry skin

3M and Cavilon are trademarks of 3M.Please recycle. © 3M 2013. All rights reserved.

Critical & Chronic CareSolutions Division3M New Zealand Limited94 Apollo Drive Rosedale 0632Freephone 0800 80 81 82www.Cavilon.co.nz

Critical & Chronic CareSolutions Division3M Australia Pty. LimitedABN 90 000 100 096Building A, 1 Rivett RoadNorth Ryde NSW 2113Phone 1300 363 878www.Cavilon.com.au