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Counties Manukau DHB steps up to the challenge of reducing pressure injuries

12 October 2012Heather Lewis CMDHB pressure injuries300
Pressure injuries can result in significant harm to the patient and are a financial burden to the organisation. Hardly surprising then that reducing pressure injuries across the Northern Region is a key goal of the First, Do No Harm patient safety programme.

A prevention programme at Counties Manukau DHB is already showing good results and provides valuable experience for other organisations not yet as advanced on their journey to reduce pressure injuries.

In May 2009 Counties Manukau DHB carried out its first annual audit to determine the rate of pressure injuries acquired at Middlemore Hospital. The audit showed the Pressure Injury Prevalence was 20.9 per cent with the number of Hospital Acquired Pressure Injuries as 10.4 per cent.

“We knew we could improve on that and set a target to reduce inpatients acquiring preventable pressure injuries. Early indications are we will exceed our 2013 goal,” says Heather Lewis, Charge Nurse Manager and leader of the DHB’s Pressure Injuries Working Group.

The Group began with problem analysis, which identified four main areas of concern.

  • Pressure Injury Risk Assessment was not always completed on patients when they were admitted.
  • Reporting was inconsistent. There was no feedback and it took too long to submit an incident report, or staff feared repercussion.
  • The bundle of care was not always implemented or was applied inconsistently, with new terminology contributing to this problem.
  • Equipment was not always being used correctly.

Solutions were then developed and tested for effectiveness for each of the problem areas.

  • Monthly random audits (five patients/ward) were introduced in February 2011. This process has provided more timely, accurate information than voluntary reporting, which was found to be an unreliable source for capturing this information. The random monthly audit has shown an average of four per cent of patients acquire pressure injuries during their hospital stay (see control chart below).
  • The rate of risk assessments completed is also measured during the monthly random audits.
  • A combined standardised risk assessment tool (WATERLOW) and bundle of care for pressure injury prevention form was introduced in July 2011. This tick list form has been adapted specifically for Counties Manukau requirements and includes easy to use checks for incident reporting.
  • A standardised resource folder was developed for use in each ward. This provides useful information for new staff in particular.
  • Information leaflets have been developed to help patients and their families manage pressure injuries.
  • Guideline and policy documents help ensure staff fully understand how to use the new material.CMDHBAuditChart


These are components of a comprehensive training and education push that will help Counties Manukau DHB reduce hospital-acquired pressure injuries to the extent that any pressure injury becomes an exception requiring investigation.

Heather says even though they have already made a lot of progress, there are many exciting new initiatives in the pipeline.

“These include further education for wound care coaches, as well as further work with theatres and Emergency Care to develop pressure injury prevention in these areas.

“We have an e-Learning package around pressure injuries currently under development. This will be linked to a staff competency and accreditation process. Developed in-house, its roll-out later in the year will be something to celebrate and we look forward to sharing it with the wider sector.

“We are also in the process of developing a standardised process for the selection and ordering of Pressure Injury prevention equipment. Once this process has been developed we will arrange for a robust education plan for the correct usage of the equipment.”