pressure injury prevention and management strategies in

Prepared by Fleur Trezise

Clinical Nurse Consultant/Transitional Nurse Practitioner

Bankstown Lidcombe Hospital

March 2014

Pressure Injury Prevention and Management Strategies in

SWS LHD Assessment and eMR

Background

Waterlow Risk Assessment Tool already in eMR and well

accepted by staff

Changes to Pressure Injury Staging systems

Standardised paper Wound Assessment and Treatment tool

used across SSWAHS and SLHD – difficult to audit

compliance or wound outcomes

Standard 8 compliance requirements

Process

SSWLHD/SLHD wound clinicians met to prioritise need

Pressure Injury module considered highest priority

Pressure injury pathway developed

Met with eMR to develop wound module

To commence Pressure Injury documentation through Cerner Powerchart, the patient can

be selected from an inpatient location List, a Community location list or via the search

functionality

Wound assessment & dressing documentation is performed in the I-View module of

Cerner Powerchart. Currently only “Pressure Injury” is available under Wounds band

The Pressure injury site is uniquely identified in the Dynamic Group label using

standardised anatomical location terms

Reference guides are available by clicking on blue text fields (Image1)

Each stage displays a visual and a graphic representation of tissue damage (Image2)

Image 1

Image 2

Wound bed description selections are appropriate to the stage of the injury

Stage 1 Pressure

Injury

Stage 4 Pressure

Injury

Pressure injury stage is selected (Image1)

Reference provides a definition of the stage (Image2)

Image 1 Image 2

Completing wound Assessment

documentation in I-view

Flag annotations can provide treatment guidelines

to wound management

Annotation created and signed. The annotation can be

entered directly or pasted from another source

(Microsoft Word etc)

By selecting the flag button all flagged results and

annotations can be clicked on for viewing

Annotations can be viewed by hovering over the icon or opened by double clicking.

Wound dressing documentation is optional after

completing the Pressure Injury wound assessment.

Primary, secondary or both can be chosen

Wound

Dressing

documentation

Primary Dressing types have visual representation attached for identifying the product type with the

dressings available

Documentation completed

Super Absorbent chosen as Secondary dressing

Signed by clicking on the green arrow

If there are a number of charted values that don’t change

very often, ability to click on signed result column to copy

results from previous charting to new column and modify as

necessary

Graphing option available in the wounds band for tracking

numeric results

Individual users can set their own timeframes and create

their own graphs providing the data element is a numeric.

E.g. adding a temperature graph. Graphs can be copied

and/or printed

Digital media & Pressure Injury

Management in eMR

The Cerner Multi Media Manager is the application used

for inserting digital images into the Patient’s eMR

Launch the Multi-Media Manager. The tool for including photographic images in the eMR .

Images are located from the correct location on the

network drive & although they default to listed view, you

have the ability to select thumbnail view for checking

the image to be included

The image is selected and you then click on double

arrow icon to move image into Wound photos folder

There is an annotation tool that allows for labelling

images and inserting symbols to indicate pain,

undermining etc

Images are now saved to the patient’s media files,

where they can be loaded and compared with other

images or attached to Clinical documents

Wound healing progress observation in the Cerner

Image viewer

Up to 4 images can be loaded at one time. Tools are

available for copying, printing , zooming in and out

etc.

Management Plan Powernote including “Macros”.

Approved standardised text can be pasted under appropriate

headings and Macros can be inserted as is or modified at an

individual patient level

Images and standardised Management plans can be inserted into signed Clinical

document.

This posts to Clinical notes & Flow-sheet

Discharge/transfer information can now

incorporate detailed wound management and

progress information

Where to from here?

Module to be piloted on two wards at Bankstown

Hospital

Wound resource nurses being trained as super-users

with ability to add digital media to the eMR

All staff will be able to perform the wound

assessment and treatment plan sections

Plans for further modules including skin tears and

burns

Acknowledgements

SSWLHD & SLHD Wound Groups

The eMR team and report writers from the Information and

Technology Division, Sydney & South Western Sydney

LHDs