The staging conundrum Gillian O’Brien 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 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? 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 of the surrounding skin. 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. 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? CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
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 CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
Sacral Pressure Ulcer CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
Category 3 PU • Aims • Offload • Debride- Larvae • Topical negative pressure • Full MDT CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
Category 4 CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
Category 4 • Sepsis • Aims • Reduce bacterial load- debridement • Offload • TNP • Periwound skin management • MDT input CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
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 CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
Gillian O’Brien ANP Tissue Viability NGH Dublin Mid-Leinster Group Twitter: @NationalQI Web: www.qualityimprovement.ie Email: Phone: CHAMPION PARTNER ENABLE DEMONSTRATE @NationalQI www.qualityimprovement.ie
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