SKINtelligence Dr. Catherine O’Sullivan Chief Executive Thames Valley Knowledge Team

SKINtelligenceDr. Catherine O’Sullivan

Chief ExecutiveThames Valley Knowledge Team

Aim The purpose of SKINtelligence is to improve the care of the elderly, across the whole system, for

ever; by introducing transferable and easily managed quality improvement methodologies

across health and social care in the Thames Valley; focusing on skin care

Range of partners to date…• 58 care/residential/nursing homes• 2 acute Trusts• 2 Community and Mental Health Trusts• 2 CCGs• 2 local authorities• 11 industry partners• 1 university

Adams & Bedford Ward Team:

39 bedded elderly care ward

Over 60 nursing and CSW staff

Diverse mix of staff

High incidence of pressure ulcers

Tissue Viability Team:

New team

Cover 4 geographical sites of a large teaching hospital

Range of knowledge and experience

Process dataBaseline (03/04/14): More recent (28/08/14):

Process data so far…

Safety cross

A group of CSW staff on the ward overheard testing each other on the

SSKIN bundle – reciting what the letters stand for

A patient’s relative seen bringing in extra snacks and drinks to tempt patient after

being given an information leaflet on

pressure ulcer risk and being told about

the link with nutritional status

A group of doctors on a ward-round asking what the

patient’s door sign meant and being

told about the SSKIN bundle and

how to prevent pressure damage

A patient’s visitor overheard

encouraging a patient to reposition

themselves after being given a patient information leaflet on

pressure ulcer risk

A CSW on the ward overheard telling a student nutritionist

about the links between nutritional status and pressure

ulcer risk and wound healing

2 registered nurses saying how much the project and introduction of

SSKIN bundle have affected their

practice, saying about Risk

Assessment “It really makes sense

to me now”

Change in focus……26 bed residential homeIn Slough, in east Berkshire

Project Engagement

Since the start of April 2014, Eton House has been part of the SKINtelligence Project.

Attended the first phase of the IHI Quality Improvement workshops.

The workshops have helped us to understand how to go about creating an improvement in any aspect of the service we provide here.

We are hoping to send two more staff to the next phase of IHI Quality Improvement workshops.

ETON HOUSE RESIDENTIAL HOME

SKINtelligence Project - Summer 2014

SKIN INSPECTION

Regular inspection of skin (twice daily) from the staff whenever personal care is provided.

This is recorded on care management system as skin inspection.

This is then passed over during handover to ensure continuity of care.

Any red areas are reported to the senior on duty, on discovery.



SURFACES

We make sure appropriate pressure relieving equipment is being used.

Referrals are made to district nurses wherever there is a need for pressure relieving equipment.



KEEP MOVING

Residents are encouraged to walk and mobilise as much as possible.

For bed bound residents, there is a need to ensure there is regular turning.



INCONTINENCE

Regular toileting is encouraged.

Personal care is carried out regularly.

Creams and moisturisers are used to keep skin moist.

NUTRITION

Balanced diet and regular fluid intake.

Appropriate monitoring of food/fluid intake in place where necessary.

Introduced fruit option for all residents every morning and exotic fruit option for all residents, once a month.

Weight monitoring.





What we are doing – care records.

When carers carry out personal care, they will put a skin inspection note in as well that will highlight whether there are any red areas or sores.

This then appears in the handover report and can be passed over to the next shift for monitoring/action as appropriate.


Skintelligence Project - Summer 2014

What we are doing – measurement.

We will measure how well we’re doing and have an A3 chart to display the number of days without avoidable pressure sores.

This will have number of days in the y axis and dates of the year in the x axis.

This graph will be displayed in the staff office as a praise for the staff (hopefully!) – or as a way to motivate the staff to improve.



Transparent displays of days since last avoidable harm

31st Janu-ary 2014

28th Febru-ary 2014

31st March 2014

30th April 2014

31st May 2014

19th June 2014

20th June 2014

30th June 2014

31st July 2014

26th August 2014

Days without Avoidable Pres-sure Sore

170 198 229 259 290 308 1 11 42 68

25

75

125

175

225

275

325

170198

229259

290308

1 1142

68

Eton House Residential Home - Days without Avoidable Pressure Sore

Days

with

out A

voda

ble

Pres

sure

Sor

e

One Self-care resident / grade

2

Snapshots in time…• Regular measurement• Each team carries out baseline assessment• Set local goals for improvement• Very contextually driven• Cannot set simple targets across a complex

system• Can adopt similar approaches, methods and a

culture of openness

The Safety Cross in use

Some more homes…

In conclusion…• Range of different partners• Working together right across the system• Measuring harm• Setting targets for improvement• Sharing progress openly with patients and

residents

Documents

SKINtelligence Dr. Catherine O’Sullivan Chief Executive Thames Valley Knowledge Team