1. SKINtelligence Dr. Catherine O’Sullivan Chief Executive Thames Valley Knowledge Team

2. Aim The purpose of SKINtelligence is to improve the care of the elderly, across the whole system, for ever; by introducing transferable and easily managed quality improvement methodologies across health and social care in the Thames Valley; focusing on skin care

3. Range of partners to date… 58 care/residential/nursing homes 2 acute Trusts 2 Community and Mental Health Trusts 2 CCGs 2 local authorities 11 industry partners 1 university

4. Adams & Bedford Ward Team: 39 bedded elderly care ward Over 60 nursing and CSW staff Diverse mix of staff High incidence of pressure ulcers Tissue Viability Team: New team Cover 4 geographical sites of a large teaching hospital Range of knowledge and experience

5. Process data Baseline (03/04/14): More recent (28/08/14):

6. Process data so far…

7. Safety cross

8. A group of CSW staff on the ward overheard testing each other on the SSKIN bundle – reciting what the letters stand for A patient’s relative seen bringing in extra snacks and drinks to tempt patient after being given an information leaflet on pressure ulcer risk and being told about the link with nutritional status A group of doctors on a ward-round asking what the patient’s door sign meant and being told about the SSKIN bundle and how to prevent pressure damage A patient’s visitor overheard encouraging a patient to reposition themselves after being given a patient information leaflet on pressure ulcer risk A CSW on the ward overheard telling a student nutritionist about the links between nutritional status and pressure ulcer risk and wound healing 2 registered nurses saying how much the project and introduction of SSKIN bundle have affected their practice, saying about Risk Assessment “It really makes sense to me now”

9. Change in focus… …26 bed residential home In Slough, in east Berkshire

10. Project Engagement Since the start of April 2014, Eton House has been part of the SKINtelligence Project. Attended the first phase of the IHI Quality Improvement workshops. The workshops have helped us to understand how to go about creating an improvement in any aspect of the service we provide here. We are hoping to send two more staff to the next phase of IHI Quality Improvement workshops.

11. SKIN INSPECTION Regular inspection of skin (twice daily) from the staff whenever personal care is provided. This is recorded on care management system as skin inspection. This is then passed over during handover to ensure continuity of care. Any red areas are reported to the senior on duty, on discovery.

12. SURFACES We make sure appropriate pressure relieving equipment is being used. Referrals are made to district nurses wherever there is a need for pressure relieving equipment.

13. KEEP MOVING Residents are encouraged to walk and mobilise as much as possible. For bed bound residents, there is a need to ensure there is regular turning. INCONTINENCE Regular toileting is encouraged. Personal care is carried out regularly. Creams and moisturisers are used to keep skin moist.

14. NUTRITION Balanced diet and regular fluid intake. Appropriate monitoring of food/fluid intake in place where necessary. Introduced fruit option for all residents every morning and exotic fruit option for all residents, once a month. Weight monitoring.

16. What we are doing – care records. When carers carry out personal care, they will put a skin inspection note in as well that will highlight whether there are any red areas or sores. This then appears in the handover report and can be passed over to the next shift for monitoring/action as appropriate.

17. What we are doing – measurement. We will measure how well we’re doing and have an A3 chart to display the number of days without avoidable pressure sores. This will have number of days in the y axis and dates of the year in the x axis. This graph will be displayed in the staff office as a praise for the staff (hopefully!) – or as a way to motivate the staff to improve.

18. Transparent displays of days since last avoidable harm One Self-care resident / grade 2

19. Snapshots in time… Regular measurement Each team carries out baseline assessment Set local goals for improvement Very contextually driven Cannot set simple targets across a complex system Can adopt similar approaches, methods and a culture of openness

20. The Safety Cross in use

21. Some more homes…

22. In conclusion… Range of different partners Working together right across the system Measuring harm Setting targets for improvement Sharing progress openly with patients and residents