1. Quality Indicators in Residential Aged Care Services (RACS) Pressure Injuries Indicator

2. What are the Victorian Residential Aged Care Quality Indicators all about ? The online resource:  Enhances knowledge of residential aged care QIs  Explains how to use them as part of your improvement toolbox 2 Why?  Helps residential aged care facilities monitor and focus on areas of high risk to residents  Improves resident quality of care and quality of life

3. 1. The What: What do we want to achieve by monitoring pressure injuries? It’s important to know the proportion of your residents with pressure injuries and the trends and scope of the issue so you can take action to:  Reduce pain and suffering in residents with pressure injures  Implement strategies for preventing pressure injures The lower target rate for stages 1 to 4 is zero. Only Stage 1 and 2 pressure injuries have an upper rate. Note that there are no reference ranges for: unstageable pressure injuries or suspected deep tissue injury. Quality Indicators in RACS Resource: Pressure Injuries3 Recommended reference range Pressure injuries per 1,000 occupied bed days MeasureLower target rate Upper limit rate Stage 101.2 Stage 200.3 Stage 300 Stage 400

4. 2. The Why: Why is monitoring pressure injuries important? Evidence shows that up to 42% of people who live in residential aged care services may have a pressure injury, which can develop as a result of:  friction and shearing forces  age and medication-related changes to skin  poor nutrition  decreased mobility  chronic disease  incontinence  restraint. Quality Indicators in RACS Resource: Pressure Injuries4 Pressure injury infection is associated with death. From 2001-2003 in Australia, 923 deaths occurred as a result of pressure injury, of which 30% occurred in Victoria. Adverse events or harm associated with pressure injuries include:  death  infection and cellulitis  reduced physical function  pain

5. 3. The How: How to collect and report this indicator How many/how often? Six measures for pressure injuries Every resident Every Quarter Quality Indicators in RACS Resource: Pressure Injuries5 How do you collect and report the data? Ask resident for permission Conduct full body assessment Count and record all observed pressure injuries and the residents they relate to Classify the pressure injuries – ask if unsure Record on data recording sheet with comments Note that the Pressure Injury Indicator has no exclusions Include respite residents Quick tips for accurate data collection  Use actual observation around the same time each quarter  Count every pressure injury  Be consistent  Do not rely on incident reporting!

6. 4. Definitions are important! A pressure injury is a localised injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, sheer, or a combination of these factors. Previous terms used included pressure ulcer, bed sore and decubitus ulcer. In Australia, as part of the Pan Pacific region, the term pressure injury has been adopted and should be used. See the QIs Resource Materials for classification and staging details – and supporting evidence! Quality Indicators in RACS Resource: Pressure Injuries6 Stage 1 pressure injury: non-blanchable erythema Stage 2 pressure injury: partial thickness skin loss Stage 3 pressure injury: full thickness skin loss Stage 4 pressure injury: full thickness tissue loss Unstageable pressure injury: depth unknown Suspected deep tissue injury: depth unknown

7. Quality Indicators in RACS Resource: Pressure Injuries7

8. Quiz 1.True or False: Pressure injuries can cause death  True  False 2. Residents to be excluded from the pressure injuries indicator data collection are: A.Respite residents B.Residents receiving end stage palliative care C.Residents who were admitted to the facility with a pressure ulcer D.None of the above Quality Indicators in RACS Resource: Pressure Injuries8

9. 3. True or False: The Pressure injuries indicator can be collected using incident reports  True  False 4. Pressure injury data will be more accurate if: A.Staff are trained to stage pressure injuries B.The pressure injury data is derived from the residents’ records C.A and B D.A only Quality Indicators in RACS Resource: Pressure Injuries9 Quiz

10. 5. True or False: People over 70 are more at risk of developing a pressure injury  True  False 6. The upper limit rate of the reference ranges for a stage one pressure injury is 1.2 per 1000 bed days. If your organisation’s rate is higher than this, it means: A.Your pressure injury care may sub-optimal B.You may have a problem with staging and counting C.You should investigate to see if there is a special cause D.All of the above Quality Indicators in RACS Resource: Pressure Injuries10 Quiz

11. How did you go? Quality Indicators in RACS Resource: Pressure Injuries11 Quiz

12. Using Quality Indicators to make a positive difference to resident care Quality Indicators in RACS Resource: Pressure Injuries18 End of Pressure Injuries Indicator

13. Quality Indicators in RACS Resource: Pressure Injuries19 To receive this publication in an accessible format email acqiu@dhhs.vic.gov.au Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services, December 2015 Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. ISBN 978-0-7311-6825-5 (Online) Available at www.health.vic.gov.au/ageing-and-aged-care/residential-aged-care/safety-and- quality/workforce-training-development/online-training