The staging conundrum Gillian OBrien ANP Tissue Viability NGH - - PowerPoint PPT Presentation

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Sep 12, 2023 21 likes •191 views

The staging conundrum Gillian OBrien ANP Tissue Viability NGH Dublin Mid-Leinster Group CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie The staging conundrum Mr X 71 year old was admitted with urosepsis

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

Gillian O’Brien

The staging conundrum

ANP Tissue Viability NGH Dublin Mid-Leinster Group

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

The staging conundrum

Mr X 71 year old was admitted with urosepsis and delirium.

He was confused and agitated, constantly moving his legs to get out of bed to get to the toilet. He developed a left leg heel blister. What stage is this? What should be done from an MDT perspective?

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

The staging conundrum

This is a large blister over the heel area caused by friction and

shear secondary to agitation and rubbing his heels along the bed sheets.

Full assessment on admission is important to determine when

the blister occurred .

The real clue to the extent of damage lies within the condition
f the surrounding skin.

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

The staging conundrum

According to the HSE 2018 guidelines, this is a category/stage

2 pressure ulcer as it presents as an intact serum filled blister.

The correct staging will depend on the type of fluid inside the

blister and the condition of the surrounding skin.

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

Blister Management

Drain the blister?
Risk it bursting during a heel strike on mobilisation?
Drain it in appropriate manner?
What is appropriate – to de-roof or aspirate ?
Efforts made to offload the heel where appropriate to promote

healing & prevent further damage?

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

Category 4 PU

Cause- inappropriate compression on ischemic limb
Visible tendon
Offload- boots
Vascular review
Dry in view of PAD

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

Sacral Pressure Ulcer

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

Category 3 PU

Aims
Offload
Debride- Larvae
Topical negative pressure
Full MDT

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

Category 4

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

Category 4

Sepsis
Aims
Reduce bacterial load- debridement
Offload
TNP
Periwound skin management
MDT input

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

Important points

Follow the guidelines
Describe and document what you see
React to red, daily skin inspection
PU development requires a bony prominence or medical device
Buddy up if unsure
MDT input required
Cheaper and better to prevent than treat
Get the patient / family/carer involved asap
SRE open disclosure

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CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie

Twitter: @NationalQI Web: www.qualityimprovement.ie Email: Phone:

Gillian O’Brien

ANP Tissue Viability NGH Dublin Mid-Leinster Group