pressure injury prevention and management strategies in
TRANSCRIPT
![Page 1: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/1.jpg)
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
![Page 2: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/2.jpg)
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
![Page 3: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/3.jpg)
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
![Page 4: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/4.jpg)
![Page 5: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/5.jpg)
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
![Page 6: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/6.jpg)
Wound assessment & dressing documentation is performed in the I-View module of
Cerner Powerchart. Currently only “Pressure Injury” is available under Wounds band
![Page 7: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/7.jpg)
The Pressure injury site is uniquely identified in the Dynamic Group label using
standardised anatomical location terms
![Page 8: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/8.jpg)
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
![Page 9: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/9.jpg)
Wound bed description selections are appropriate to the stage of the injury
Stage 1 Pressure
Injury
Stage 4 Pressure
Injury
![Page 10: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/10.jpg)
Pressure injury stage is selected (Image1)
Reference provides a definition of the stage (Image2)
Image 1 Image 2
![Page 11: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/11.jpg)
Completing wound Assessment
documentation in I-view
![Page 12: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/12.jpg)
Flag annotations can provide treatment guidelines
to wound management
![Page 13: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/13.jpg)
Annotation created and signed. The annotation can be
entered directly or pasted from another source
(Microsoft Word etc)
![Page 14: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/14.jpg)
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.
![Page 15: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/15.jpg)
Wound dressing documentation is optional after
completing the Pressure Injury wound assessment.
Primary, secondary or both can be chosen
Wound
Dressing
documentation
![Page 16: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/16.jpg)
Primary Dressing types have visual representation attached for identifying the product type with the
dressings available
![Page 17: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/17.jpg)
Documentation completed
Super Absorbent chosen as Secondary dressing
Signed by clicking on the green arrow
![Page 18: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/18.jpg)
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
![Page 19: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/19.jpg)
Graphing option available in the wounds band for tracking
numeric results
![Page 20: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/20.jpg)
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
![Page 21: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/21.jpg)
Digital media & Pressure Injury
Management in eMR
![Page 22: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/22.jpg)
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 .
![Page 23: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/23.jpg)
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
![Page 24: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/24.jpg)
The image is selected and you then click on double
arrow icon to move image into Wound photos folder
![Page 25: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/25.jpg)
There is an annotation tool that allows for labelling
images and inserting symbols to indicate pain,
undermining etc
![Page 26: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/26.jpg)
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
![Page 27: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/27.jpg)
Wound healing progress observation in the Cerner
Image viewer
![Page 28: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/28.jpg)
Up to 4 images can be loaded at one time. Tools are
available for copying, printing , zooming in and out
etc.
![Page 29: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/29.jpg)
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
![Page 30: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/30.jpg)
Images and standardised Management plans can be inserted into signed Clinical
document.
This posts to Clinical notes & Flow-sheet
![Page 31: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/31.jpg)
Discharge/transfer information can now
incorporate detailed wound management and
progress information
![Page 32: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/32.jpg)
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
![Page 33: Pressure Injury Prevention and Management Strategies in](https://reader036.vdocument.in/reader036/viewer/2022062321/62a9a656a4198b5aa20fead9/html5/thumbnails/33.jpg)
Acknowledgements
SSWLHD & SLHD Wound Groups
The eMR team and report writers from the Information and
Technology Division, Sydney & South Western Sydney
LHDs