SCGH Wound Care Products and General Advice

Nicole Walsh,Nurse Practitioner Wound

Management

Lola’s story – Traumatic Skin TearPlease tell my story• First documented inspection

of skin- at 36 hrs• Frail / Fragile skin• Pain and suffering

Identification of Risk of Injury

• STAR Staging• NPGL• Gently roll out any clots• Approximate edges• No sutures/staples• No steri stripes• No adherent dressings• No adherent tapes.

• Use soft silicon mesh eg Mepitel,• Apply so onto healthy skin• It is a very tacky dressing non adherent silicon • Moistening your cotton bud

Calcuim Alginate

• Flat sheet of Calcuim Alginate if bleeding continues to assist with Haemostasis

• Goes over top of Mepitel and is removed gently by irrigating with normal saline in 24 hrs.• Mepitel remains in situ

Pressure Injury or Skin Tear Alert Sticker

It has been introduced to:• Alert staff of an identified pressure injury or skin tear • Ensure each injury is appropriately classified and

clearly documented in the notes – to support clinical coders.

• Ensure injuries are accurately coded so that the hospital does not lose funds in relation to the ABM/ABF model.

• Improve reporting of injuries to inform prevention strategies for the future

Mepilex Boarder Flex

• Oval shaped all-in-one foam dressing – easy to use and fits body contours

• Absorbent pad with flex technology – very flexible and conformable

• Less painful for patients at dressing changes – less stress for patients, easier care

• Atraumatic to the wound and surrounding skin at dressing removal3 – undisturbed healing

• Excellent exudate management – reduced risk of leakage and maceration

Mepilex Boarder Heel

All-in-one dressing shaped to fit the heel – easy to use, time-saving dressing changes

• Atraumatic to the wound and to the surrounding skin at removal1 – undisturbed healing

Mepilex Heel

Melgisorb Ag

Silver-containing alginateProvides sustained antimicrobial effect

• Suitable for high exuding wounds• Designed for shallow and deep wounds• Allows removal in one piece

C16 C17

CT Scan

DO23

Emergency Departm

ent G41

G42

G45 GHDU

G51 G53

G54 G61

G62 G63

G64 G66

G71 G72

G74

Gairdner R

ehab Unit

HITH

Intensive Care U

nit PACU

Theatres

0

5

10

15

20

25

30

35

CIM'S Data Recorded Pressure Injuries

Not Present on Admission Present on Admission Unknown if present on admission Total

Pressure Injuries – July to DecemberCIMS

Stage 1 - non-blanchable erythema

Stage 2 - partial thickness skin loss

Stage 3 - full thickness

Suspected deep tissue injury - depth unknown Unknown

Unstageable - depth unknown Total

Jul 6 3 0 0 1 0 10Aug 9 4 1 1 3 0 18Sep 6 9 0 0 1 0 16Oct 7 5 0 0 1 0 13Nov 6 5 0 0 1 1 13Dec 7 4 0 0 0 0 11Total 41 30 1 1 7 1 81

SCGH - Wound Management Product changesProduct Removed Replaced by Company

Calcium Alginate Ribbon

Kaltostat Rope • Calcium Alginate Biatain Alginate

Coloplast

Calcium Alginate with Ag

Silvercel • Calcium Alginate with Ag

Melgasorb Ag

Molnlycke

Post Island Dressing Opsite Cutiplast

• Tegaderm Island• Mepore Island

Tape & Film• Mepilex Island

3MMolnlycke

Absorbent Pads Relevo ( Drymax ) • Zetuvit Plus• Exudry

HartmannSmith & Nephew

Tapes TransporeYuki Ban

• Blenderm• Kind Remove

Silicone Tape

3M

Hydro Capillary AlioneVacutex

Not replaced

Additions New products Additional Information

Company

Soft Silicon Foam Mepilex Heel shaped – non adhesive

Also comes in contoured heel shaped/ adhesive

May be re used if skin intact. Hold insitu with TED stocking/tubular band/non slip sock

Consider for very restless patients

Molnlycke

Hydro Fibres – Ribbon sizes

Aquacel Ribbon Strengthening fibres

Now comes in a 1cm for narrow sinus’s as well as 2cm

Convatec

Skin Barrier Cream Cavilon – more extensive range found on continence contract

Barrier cream, single use sachets, wipes, paddles & spray’s

3M

Product Types of dressings Additional Information Company

Silicon Foam Mepilex range Prophylactic dressing can be lifted for skin inspection and reapplied

Molnlycke

Gels Intrasite ConformibleHydrosorb gel sheet available dressing bank

Smith & Nephew

Hartmann

Antimicrobials • AMD non adherent • AMD Foam

High risk patient onlyCoviden

Antimicrobial •Inadine•Iodosorb ointment•Iodosorb powder

Smith & Nephew

Silver Dressings Atrauman AgAquacel AgMelgasorb AgActicoatMepilex AgBiatain Ag

Ag TulleAg Hydro FibreAg Calcium AlginateAg Flex /ClothAg Silicon FoamAg Foam

HartmansCovidenMolnlyckeSmith & NephewMolnlykeColoplast

SCGH Pressure Injury Prevalence Data

2007 2008 2009 2011 2013 20140

2

4

6

8

10

12

P.I Prevalence Data: May 2007 -2014RPH and SCGH com-parison Grade 2 pressure in-juries and above

5.3% Total No HAPI

11 %

%

2014 State Wide data :

Total No Patients : 2974

Total No HAPI : 5.7%

Excluding Stage 1 : 2.2%

SCGHTotal No Patients :

445Total No HAPI :

5.3%Excluding Stage 1 :

3.4%

Key Information from the 2014 pressure injury prevalence data

• 79.6% of patients on the day had a skin inspection

• Braden scores indicated that 42.9% of patients were identified at risk (either moderate-high risk) of developing a pressure injury. This equates to 202 patients on the day.

• Currently we have 185 air mattresses in the hospital– 115 for high to very high risk patients– 70 for moderate / at risk patients

• 72.1% of patients had a skin assessment documented within 8 hours of admission.

• 12% of the patients with a pressure injury were recorded as device related e.g. IDC, nasal prongs

Key Information from the 2014 pressure injury prevalence data

• 49% of patients assessed with a pressure injury did not have any documentation in the medical or nursing notes identifying a pressure injury

• The patients that were identified as having a pressure injury 56.1% had more than one

• Evidence shows that 50% stage one pressure injuries develop into stage 2 and 3