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
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”
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.
ETON HOUSE RESIDENTIAL HOME
SKINtelligence Project - Summer 2014
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.
ETON HOUSE RESIDENTIAL HOME
SKINtelligence Project - Summer 2014
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.
ETON HOUSE RESIDENTIAL HOME
SKINtelligence Project - Summer 2014
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.
ETON HOUSE RESIDENTIAL HOME
SKINtelligence Project - Summer 2014
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.
ETON HOUSE RESIDENTIAL HOME
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.
ETON HOUSE RESIDENTIAL HOME
SKINtelligence Project - Summer 2014
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