1009 / A Digital Database for the Recording and Monitoring of Pressure Ulcers

SPAIN
Classification of the PSP
Type of Patient Safety Practice Not Evaluated
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Decubitus ulcers
Health IT There is no specified text here
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
There were not any available means for the recording and assessment of pressure ulcers (PU), through the already implemented digital medical-records software known as ‘Diraya’. Therefore, recording was done on paper. This, in turn, hindered the assessment of the quality of nursing care and made resources allocation inefficient.
A suited digital system for the recording and evaluation of pressure ulcers should be embedded within Diraya. This is thought to be useful in the monitoring of trends of PU incidence as well as the assessment of variation in clinical practice. Consequently patients would capitalize on the improved professional practice.

Contribution of the registry, follow-up and assessment of chronic wounds:

1. Addressee: organization
1.1. Method
•Providing standardised treatment for skin care and pressure ulcer (PU) prevention
•Assuring resources for patients and health-care staff
•Providing appropriate training for health-care professionals
•Guaranteeing documentary evidence, within clinical registries, of the care plan

2. Addressee: health-care professionals
2.1. Objective: Identifying the at-risk people
2.1.1. Method
•Providing diagnostic evaluation and documentary evidence, from head to toe, in all at-risk patients
•Using clinical judgment and available assessment tools
•Identifying presence of factors affecting tolerance of tissues (e.g. patient’s age and weight).

3. Addressee: health-care professionals and patients
3.1. Objective: Development of a personalised care plan
3.1.1. Method
•Examining the skin: hygiene and care of dry skin as well as protection against excessive humidity
•Management of pressure by means of specific surfaces
•Use of local protection against pressure
•Nutritional assessment and appropriate support
•Increasing mobility and activity
•Appropriate position, transfer and postural changes

4. Addressee: health-care professionals
4.1. Objective: re-evaluation
4.1.1. Method
•Scheduled re-evaluation of patients and documentary evidence of the findings
•More frequent examination in deteriorating patients

5. Addressee: health-care professionals and patients
5.1. Method
•Teaching the patient and their families
•Which areas of the skin are the most vulnerable to PU
•How to examine the skin and recognise abnormal changes and PU
•How to alleviate or reduce the pressure on the skin

6. Addressee: the organisation
6.1. Method
•Monitoring and documenting the implementation of a standardised protocol
•Continuous surveillance of the incidence and prevalence of PU

Benefits of the practice on .
1. Patients
•Improving the quality of life of patients with PU as well as mitigating the consequences of PU upon the physical, social, economical and family environment of the patient.
•Lessening the incidence and prevalence of PU
•Early assessment of the risk of PU, in all disabled patients
•Systematic re-assessment of skin lesions
•Using the most efficient resources
2. The organisation
•Decreasing variability of clinical practice
•Supporting professional decision making
•Improving continuous health-care delivery through a single standardised registry system
•Availability of a self-evaluation system for health-care quality assurance
•Nominating nurse referees as assessors
•Strengthening of professional training plans
3. Professionals
•More efficient management of human and material resources
•Improving of drug prescription
•Obtaining epidemiological indicators of health results and time-trend
Description of the Patient Safety Practice
 
The Safety Practice consists in the design and implementation of a local digital database (DB) following Clinical Practice Guidelines (CPG) issued by the Andalusian Health Service. This DB will be used for the recording and monitoring of PU within each health-care centre that belongs in the Granada-Metropolitan Primary Care District (GM-PCD) and the socio-sanitary partner facilities. The DB will allow for the exportation of encrypted files to be hosted by the Nursing Homes Unit, at the GM-PCD
Functionality:
At the local level (health-care CMU, or socio-sanitary partner facilities) the DB will allow for:

• The assessment of variation in clinical-practice.
• The availability of a graphical report (Pressure Ulcer Scale for Healing) for the monitoring of the clinical course of PU.
• The Implementation of proposed measures for quality assurance once inefficient practices are detected.
• The implementation of preventive measures
• The efficient management of the prescription of products for the prevention and treatment of chronic wounds.
• The release of monitoring reports concerning patients with PU.
At the GM-PCD level the system will allow for::
• The assessment of clinical practice and the implementation of a suitable training strategy, after the areas for improvement are identified .
• The assessment of resources allocation needs according to the number of patients with PU.
• The identification of some epidemiological characteristics (incidence and prevalence) of PU to be used for the monitoring of PU and the benchmarking of the performance of health-care at the local, regional and national level

COST:
1. Financial resources
There are not any costs incurred by the development of the necessary software, as this tool is entirely devised and implemented by IT and clinical staff already working for the institution
2. Material resources
All hardware and software tools are already available at the health centres, within the institution.
3. Human resources
3.1. Health-care staff:
•Head of the Unit of Services for Nursing Homes:
-Professional fees: there are not any extra charges due to the practice above mentioned.
-Time slot: There are meetings scheduled for presentation, dissemination and training in the use of the software tool, for which the intended audience is
*Managerial and technical professionals within the Primary Health Care District: 1 session lasting 30 minutes
*Managerial staff within the Clinical Management Units (35 Health-Care Centres): 2 sessions lasting 45 minutes each.
*Nursing homes (72): 4 sessions lasting 2 hours each.
*Nurses working for Clinical Management Units, or Nursing Homes adhering to the practice: 1 session lasting 45 minutes, which is delivered upon request.
•Nurses working for health-care centres and nursing homes:
-Professional fees: there are not any extra charges due to the practice above mentioned.
-Time slot: Variable and dependent on the professional skills gained in the use of the software. Between 3 and 5 minutes which does not exceed the time currently devoted to this task on a (lower quality) non-digital format.
•Managerial staff:
-Time slot: This system allows for a substantive amount of time to be saved in the management and quality assurance of this process. Where this system not put into practice, clinical audits would be necessary to only achieve cross-sectional, non-continuous, assessment of the practice.
-Financial resources: A more efficient use of the available material resources is expected.
•IT staff:
-Professional fees: there are not any extra charges due to the practice.
-Time slot: Devising the current tool took 2 part-time months. Implementing the web-based version took also 2 part-time months
• Development team and web application
-Professional fees: there are not any extra charges due to the practice
-Time slot: 6 sessions lasting 4 hours each (6 nurses)
•Opportunities:
-The practice can be included in the yearly Management Agreements between the Primary Health-Care District and the Clinical Management Units
-Specific prescription by nurses, recently adopted by the Andalusian Health Service, needs evaluation.
-The current financial situation calls for the most efficient investment while treating wounds.
-Adherence of health-care centres, staff from nursing homes and health-care professionals to accreditation makes this software tool helpful in accomplishing current health-care quality standards.
-This web tool can be embedded within the patient’s digital clinical history (“Diraya”).
Attachment of relevant written information and/or photos, as appropriate
2014031412550421285_WP4_REGISTRATION PROCESS AND IMPROVEMENT PROPOSAL.zip
Appendix.pdf
IMPROVEMENT PROPOSAL.pdf
REGISTRATION PROCESS.pdf
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, partly
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
No
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Primary care
Nursing facility
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Health care assistants
Scientific staff / researchers
Technical support / technician
Clinical manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Staff and management recognised the need for change
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Not relevant
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
Yes
Total number of person days required to implement this Patient Safety Practice
Clinical staff: 30
External consultants: 1
Support staff: 30
Managerial staff: 2
Others: 0
Not relevant: 0
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: 6
External consultants: 1
Support staff: 1
Managerial staff: 6
Others: 0
Not relevant: 0
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
0
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
0
Contact information
 
Name: Vera Salmerón Eugenio
Country: SPAIN
Organisation: Servicio Andaluz de Salud / Distrito Granada-Metro
E-mail: eugenio.vera.sspa@juntadeandalucia.es
Phone: +34677905855
Print
Top