Reducing avoidable pressure injuries

Applying Pressure to the

Data.

What Can it Tell Us?

Michele Sutherland

Safety and Quality Unit

SA Department of Health

SA Health

SA Health

Introduction and overview

Pressure injuries are preventable.

> Data is most useful for us when it;

• identifies where the biggest problems

are

• guides us as to what to do next

> There are two main sources of data about

pressure injury in SA for 2013-14

• incidents during health care

• coded data

Understand the strengths and limits of

your data

SA Health

2 sources of data for all of SA

1. ICD-10 AM coded hospital data • All admissions that include

L89.0 (stage 1)

L89.1 (stage 2)

L89.2 (stage 3)

L89.3 (stage 4) and

L89.9 (stage unspecified)

• Diagnoses

• Length of stay

> Analysis of COF 1 pressure injury

• Condition onset flag (COF code)

1= * condition arose in hospital

2= condition arose prior to admission

SA Health

SA sources of data 2. Safety Learning System

The SA system for reporting incidents during health

care.

Pressure injury fields are quite new.

• Stage (1, 2, 3, 4, suspected deep, unstageable

and unknown)

• Whether the PI was

* New

Present on admission from home or external

provider

Worsening of existing, or observed after internal

transfer

• Contributing factors and interventions in place

Analysis of New PI

SA Health

What do we want the data to tell us?

Questions…

> How big / serious is the problem?

> What are the implications for people who

have pressure injuries?

> How do the 2 data sets line up?

SA Health

Comparison between ICD-10 and SLS

Total number of

pressure injuries

2012-13 2013-14

Coded from medical

records (ICD-10)

2434 2826

Reported to Safety

Learning System

(SLS)

461 1333

SA Health

Comparison between ICD-10 and SLS

Total number of

pressure injuries

2012-13 2013-14

Coded from medical

records (ICD-10)

2434 2826

* COF 1 - 709

(25%)

Reported to Safety

Learning System

(SLS)

461 1333

* New - 798

(60%)

SA Health

Stages of Pressure Injury (2013/14)

ICD-10

(COF 1, n=709)

SLS

(New n=798)

Stage 1 38 % 42 %

Stage 2 27 % 41 %

Stage 3 8 % 2 %

Stage 4 6 % 0.5 %

Unstageable - 6 %

Suspected deep - 0.5 %

Stage unknown,

unspecified

18 % 8 %

SA Health

Stages of Pressure Injury (2013/14)

ICD-10

(COF 1, n=709)

SLS

(New n=798)

Stage 1 38 % 42 %

Stage 2 27 % 41 %

Stage 1&2 65% 83%

Stage 3 8 % 2 %

Stage 4 6 % 0.5 %

Unstageable - 6 %

Suspected deep - 0.5 %

Stage unknown,

unspecified

18 % 8 %

SA Health

Admitted from…? Discharged to…?

(ICD-10, n=2826, 2013-14)

COF 1 COF 2

Accommodation type

Home 90 % 79 %

Residential aged care 8 % 16 %

Other 2 % 5 %

Discharge destination

Home 32 % 43 %

Residential aged care 16 % 20 %

Died 17 % 15 %

Other 35 % 22 %

SA Health

What do we want the data to tell us?

Questions…..

> Who is getting PI? How many PI per

person?

> Age, characteristics of patients?

> Length of stay?

> What conditions do they have?

SA Health

0

50

100

150

200

250

300

350

400

1 2 3 4 or more No value

Incidents by Total number of current pressure injury(ies) present (SLS)

SA Health

Age, and length of stay

Average Length of stay, 2013-14

(ICD-10 data)

(NB 80% of patients

were aged 65+)

COF 1 (new, hospital acquired)

All ages 33.1 days

Under 64 years 40 days

COF 2 (prior to admission)

All ages 16.7 days

Under 64 years 22.6 days

SA Health

Analysis by age group and diagnostic

grouping (ICD-10 COF 1)

COF 1

Number % Number of

diagnoses per

person

0-17 23 3 % 12.7 per person

18-64 138 19.5 % 13.2 per person

65+ 548 77.3% 11.7 per person

total 709 100%

SA Health

Pressure injury acquired during admission,

principal diagnosis and all diagnoses (n= 709,COF=, ICD-10)

0

5

10

15

20

25

A a

nd

B

C a

nd

D E F G I J K

L

M

N

O, P

an

d Q

R

S an

d T

U, W

, X a

nd

Y Z

Principal diagnosis All diagnoses

SA Health

COF 1 (n= 709 ) Principal diagnosis All diagnoses A and B 3.8 6.6 C and D 15.1 7.2 E 3.4 13.1 F 1.5 3.4 G 1.9 2.1 I 11.6 10 J 13.5 7 K 9.5 5.3 L 1.4 1.6 M 6.8 2.8 N 4.5 6.2

O, P and Q 1.5 1.3 R 3.5 14 S and T 21.2 6.5

U, W, X and Y 0 3.3 Z 0.6 8.9

SA Health

Diagnostic group

(PI COF=1) 0-17 years (%), n= 23

18-64 years (%),n=138

65+ years (%), n=548

A and B 6.2 7.9 6.3 C and D 2.1 9.1 6.9 E 4.8 12.9 13.5 F 2.7 4.2 3.2 G 1.7 2.6 2 H 0.3 0.4 0.7 I 3.4 8.1 10.8 J 5.8 7.5 6.9 K 7.5 5.6 5.1

L (except L89) 2.7 1.7 1.5 M 0.6 2.6 2.9 N 0.6 5.6 6.6 R 5.8 11.4 15.1 O, P and Q 29.8 1.4 0 S and T 13.7 7.8 5.9

U, W, X and Y 2.1 3.1 3.5 Z 9.9 8.3 8.9

SA Health

Diagnostic group (PI COF=1)

0-17 years (%), n= 23

18-64 years (%),

n=138 65+ years (%), n=548

A and B 6.2 7.9 6.3

C and D 2.1 9.1 6.9

E 4.8 12.9 13.5

F 2.7 4.2 3.2

G 1.7 2.6 2

H 0.3 0.4 0.7

I 3.4 8.1 10.8

J 5.8 7.5 6.9

K 7.5 5.6 5.1

L (except L89) 2.7 1.7 1.5

M 0.6 2.6 2.9

N 0.6 5.6 6.6

R 5.8 11.4 15.1

O, P and Q 29.8 1.4 0

S and T 13.7 7.8 5.9

U, W, X and Y 2.1 3.1 3.5

Z 9.9 8.3 8.9

SA Health

Diagnostic group

(PI COF=1) 0-17 years (%), n= 23

18-64 years (%),n=138

65+ years (%), n=548

A and B 6.2 7.9 6.3 C and D 2.1 9.1 6.9 E 4.8 12.9 13.5 F 2.7 4.2 3.2 G 1.7 2.6 2 H 0.3 0.4 0.7 I 3.4 8.1 10.8 J 5.8 7.5 6.9 K 7.5 5.6 5.1

L (except L89) 2.7 1.7 1.5 M 0.6 2.6 2.9 N 0.6 5.6 6.6 R 5.8 11.4 15.1 O, P and Q 29.8 1.4 0 S and T 13.7 7.8 5.9

U, W, X and Y 2.1 3.1 3.5 Z 9.9 8.3 8.9

SA Health

SA Health

What do we want the data to tell

us?

Questions…..

Our aim is prevention

> What are the problem areas?

> What to do next ……………………..

SA Health

What do we want the data to tell us?

Questions…..

SLS is very useful here

Contributing factors

> Patient - what was the patient like, what

were they doing / not doing?

> Environment – what was going on around

the patient’s body?

> Staff – what were staff doing / not doing?

SA Health

SA Health

Contributing factors - Patient factors (SLS, n=515, 3.2 factors per patient)

% of reports where this was selected

Impaired mobility 66.6%

Low levels of activity 55.1%

Poor nutritional status / malnutrition 36.1%

Underweight or obese 29.1%

Impaired body sensation 28.0%

Difficulty complying with prevention strategies 20.8%

Palliative, frail 20.4%

Impaired circulation or perfusion 20.2%

Oedema, swelling 15.9%

Long period of anaesthesia or sedation 11.1%

History of pressure injury(s) in the last two years 8.5%

Rash, dermatological condition(s) 3.9%

None of the above 4.7%

SA Health

The physical environment, type of

service

Location - where ?

> 69% in acute wards

> 18% in residential aged care

> 13% - other settings

Presence of moisture, pressure, shear,

friction, devices in contact with skin etc

SA Health

SA Health

Contributing factors - Environmental (SLS, n=501, 2.1 factors per patient)

% of reports where this was selected

Exposure to pressure 74.0%

Exposure to friction 37.0%

Exposure to shearing forces 29.4%

Exposure to moisture 28.0%

Presence of device(s) in contact with skin 20.8%

Exposure to poor hygiene / skin irritants 10.0%

Exposure to high skin temperatures 4.8%

None of the above 6.6%

SA Health

SA Health

What was in place to prevent the

pressure injury?

> Was there a current risk assessment?

> What equipment / strategies were in place

eg pressure mattress?

> What nursing strategies were in place?

> What team members were involved?

> Was there discussion with patient, care,

family?

SA Health

SA Health

Intervention Strategies in use / in place (SLS n= 498, 4.7 interventions per patient)

% of reports where this was selected

Current assessment of pressure risk and skin 71.3%

Pressure - eliminate or redistribute using equipment or other 55.2%

Re-positioning routine 53.2%

Encourage and assist patient positioning and mobility 46.6%

Current pressure injury prevention plan and handover 43.6%

Skin hygiene and moisture reduction strategies 37.1%

Friction - eliminate or reduce using equipment or other 28.5%

Pain assessment and management 24.1%

Manual handling technique(s) to reduce skin trauma 22.1%

Shearing - eliminate or reduce using equipment or other 21.9%

Oral nutrition supplements, feeding assistance 19.5%

Referral(s) and multidisciplinary team involved 18.3%

Consumer, family, carers involved 17.1%

Discharge planning 4.6%

None of the above 4.4%

SA Health

What went wrong?

> What good things didn’t happen? What

bad things happened?

> What was missing from the care? (delay

or failure in care)

> Did staff know what to do / what not to do?

(staff training)

> Did all staff in care team know what the

risks and plan was? (communication,

team work)

> Staff thoughts about what could have

prevented the PI?

> Was the right care provided afterwards to

promote healing / minimise harm?

SA Health

SA Health

Consumer involvement

> Were the patient and carer(s) informed)?

Safety Learning System

> 154 reports indicated that consumer,

family carer involved (18%)

> Additional analysis including the

managers report section indicated that

1006 (75%) of all 1333 PI reports to SLS

there was information provided, discussed

SA Health

Thank you

Any questions?

Michele.Sutherland@health.sa.gov.au

Safety and Quality unit

Department for Health and Ageing, SA

http://www.sahealth.sa.gov.au/wps/wcm/con

nect/Public+Content/SA+Health+Internet/Cli

nical+resources/Safety+and+quality/