TIME TO START PROJECT

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TIME TO STARTPROJECT

• QNIS CONFERENCE
• 5TH MARCH 2008

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(No Transcript)
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BACKGROUND

• Nursing Home Medical Practice
• Expenditure on wound care products
• Watret (2007) Bruce (2007)
• Challenges faced by Care Home Staff in providing
  initial wound care Empowering staff.
• Questionnaire to CHS
• Similar projects

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WOUNDS ENCOUNTERED

• Pretibial haematomas and lacerations
• Pressure / leg/ diabetic foot ulcers
• Incontinence Dermatitis
• Minor Trauma

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AIMS OBJECTIVES

• Aim of study
• To provide equity of care for the patient in the
  management of complex and superficial wounds
  regardless of their health care setting
• Objectives
• To promote best practice in wound management
• To provide a framework to promote continuity of
  care
• To promote a cost effective approach to wound
  management

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METHODOLOGY

• Funding
• 6 month pilot
• 13 Nursing Care Homes
• Provision of stock of dressings for use as
  initial dressing
• Structured Education sessions
• TIME framework
• Resource folder
• Audit form
• Ongoing support

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What is T.I.M.E?

• An approach to wound assessment
• T tissue type
• I- infection/inflammation
• M- moisture balance
• E- edge of wound
• International advisory board on wound bed
  preparation (Schultz, 2003)

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RATIONALE FOR DRESSING CHOICE

• Knowledge of commonly encountered wound types in
  care home setting
• Fit for purpose
• Should do no harm
• Familiarity
• Promote equity consistency
• Project teams clinical expertise and experience
• Evidence base
• Availability

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Dressings

• Atrauman 7.5 x 10cm
• Inadine 9.5cm x 9.5cm
• Intrasite gel 8g
• Aquacel 10 x 10cm
• Alldress 15cm x 15cm
• Opsite Plus 12cm x 10cm
• Duoderm extra thin 10cm
• Allevyn 10cm x 10cm

• K Soft 10cm x 3.5m
• Crepe bandage (Profore 2) 10cm x 4.5m
• Scanpor tape 2.5cm x 5m
• Sodium Chloride 0.9
• (steripod) 20ml
• Cavilon cream sachet (2g)
• Topper 8 non woven fabric swabs 7.5cm x 7.5cm
• Leukostrips (3) 6.4cm x 76mm

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T
I
E
M
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INCLUSION CRITERIA

• An existing resident who develops a new wound
• A new resident who is admitted to the home with a
  wound and has no dressings or has dressings which
  are considered by the nursing home staff to be
  inappropriate

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EVALUATION /FINDINGS

• 5 KEY ELEMENTS
• Analysis of audit forms
• Wound product usage
• Prescribing practice
• Post pilot questionnaire
• Expenditure

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AUDIT FORMSWOUND TYPE
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Did dressing meet initial wound care needs?
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2. WOUND PRODUCT USEAGE
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3. PRESCRIBING PRACTICE
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4. POST PILOT QUESTIONNAIRE

• 80 (n8) stated that the project met their
  patients needs
• 90 (n9) stated that the project resulted in
  treatment being started prior to a prescription
  being raised
• 50 (n5) stated that the project had prevented
  the need to keep an excess stock of dressings
• 90 (n9) agreed that the products provided were
  appropriate to their patient group
• The resource folder was felt to be a useful
  educational tool for 50 (n5)
• 100 responded that they would recommend the
  project to other care homes
• 90 would continue to participate in the project
  if this was offered

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5.EXPENDITURE
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Discussion

• Enthusiasm from care home staff
• Identified potential areas for further research
  and education
• Problems in completion of audit forms
• Dressing choice
• Cost effectiveness

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THE FUTURE

• Recommendations
• Further analysis of prescribing activity
• Roll out to all NHMP care homes
• Support of the newly formed care home liaison
  nurse team.
• Reduce range of dressings
• Ensure product selection is in concordance with
  the Wound Care Formulary soon to be widely
  implemented across NHS Greater Glasgow Clyde
• Dissemination of results at Clinical Governance
  event.
• Publication of results

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AIMS OBJECTIVES

• Aim of study
• To provide equity of care for the patient in the
  management of complex and superficial wounds
  regardless of their health care setting
• Objectives
• To promote best practice in wound management
• To provide a framework to promote continuity of
  care
• To promote a cost effective approach to wound
  management

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PROJECT TEAM

• Liz McLure - District Nurse
• Rachel Bruce - Pharmacist NHMP
• Lynne Watret- Tissue viability CNS Primary care
• Isobel Baxter - Clinical effectiveness
• Jamie Quin - Clinical Services Manager
• Liz McClusky Pharmacy technician
• Janice Bianchi Tissue viability lecturer GCU
• For futher information, contact Liz McLure
• liz.mclure_at_nhs.net

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OVER TO YOU!