1 / 38

Innovation of Skin Risk Assessment: SIRA

Innovation of Skin Risk Assessment: SIRA. Kristina L. Foster, RN, MS, APRN, BC, CWOCN Lacey Bergerhofer, RN, BSN, CCRN. Disclosures. None for either Ms. Foster or Ms. Bergerhofer. Objectives. Predict risks to neonatal and pediatric skin for developing pressure ulcers.

ira
Download Presentation

Innovation of Skin Risk Assessment: SIRA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Innovation of Skin Risk Assessment: SIRA Kristina L. Foster, RN, MS, APRN, BC, CWOCN Lacey Bergerhofer, RN, BSN, CCRN

  2. Disclosures • None for either Ms. Foster or Ms. Bergerhofer.

  3. Objectives • Predict risks to neonatal and pediatric skin for developing pressure ulcers. • Recognize SIRA as a tool to accurately identify risk of pressure ulcer development in all age groups. • Explain pressure ulcer prevention utilizing SIRA through an electronic health record.

  4. Why is skin important?

  5. Skin Facts • Skin is the largest organ of the body. • Contrary to popular belief, pressure ulcers DOoccur in the pediatric and neonatal populations. • CMS considers hospital acquired Stage III & IV pressure ulcers “Never Events” or “errors in medical care”.

  6. Layers of skin: • Epidermis • Dermis • Subcutaneous

  7. What does your skin do for you? • Protects from bacteria • Protects from ultraviolet light • Protects from other noxious substances • Regulates fluid and electrolyte loss • Helps maintain normal temperature • Aids in sense of touch • Aids in metabolism (vitamin D) • Communication

  8. Skin issues in pediatric patients • Perineal/Perianal Dermatitis • Pressure Ulcers • IV Infiltrates • Device-related injuries • Epidermal injuries Noonan, Quigley & Curley 2006

  9. Pressure ulcers in peds • Pressure ulcer prevalence rates in hospitalized pediatric patients range from 0.47% among non-critical to as high as 27% or more among the critically ill. Baharestani & Ratliff 2007

  10. Risks specific to pediatric population • More than 50% of all pressure ulcers in neonates and children are device related • Neonates have immature skin and therefore decreased tissue tolerance Baharestani & Ratliff 2007

  11. Pediatric Skin Risk Assessment • 10 published pediatric pressure ulcer risk assessment scales • Only Braden Q, Glamorgan and Neonatal Skin Risk Assessment Scale (NSRAS) have been tested for sensitivity and specificity Baharestani & Ratliff 2007

  12. Glamorgan • Reviewed adult and pediatric literature on PU to develop questionnaires used to survey patients • Developed tool statistically based on patient data • Suggested for birth through 18 yrs of age • Includes 9 risk factors • Mobility • Equipment/objects/hard surface pressing or rubbing on skin • Significant anemia (Hgb less than 9) • Persistent pyrexia (greater than 100˚ F for more than 4 hours) • Poor peripheral perfusion • Inadequate nutrition • Low serum albumin (less than 3.5) • Weight less than 10th percentile • Incontinence (inappropriate for age) Willock, Baharestani, & Anthony, 2009

  13. Requested the article electronically

  14. Braden • Developed for PU risk identification in adult residents of nursing homes • Includes 6 subscales • Mobility • Activity • Sensory Perception • Moisture • Friction-Shear • Nutrition • Uses a 4-point scale for each subscale • 1 being high risk • 4 being no risk Bergstrom, Braden, Laguzza, & Holman, 1987

  15. Braden Q • Developed for PU risk identification in children aged 21 days to 8 yrs • Includes the original 6 subscales of the Braden scale for adults • Mobility • Activity • Sensory Perception • Moisture • Friction-Shear • Nutrition • Adds a seventh subscale for tissue oxygenation and perfusion • Uses a 4-point scale for each subscale • 1 being high risk • 4 being no risk Quigley & Curley 1996

  16. NSRAS • Also modeled after Braden • 6 subscales pertinent to neonates • General physical condition • Mental status • Mobility • Activity • Nutrition • Moisture • Also uses a 4 point scale • 1 being no risk • 4 being high risk Huffines & Logsdon 1997

  17. Skin Risk Assessment

  18. Introducing SIRA • SIRA: Skin Integrity Risk Assessment • Goals were to create a risk assessment tool that is: • Easy to use • Easy to understand • Suitable for all ages • Combines aspects of Braden, Braden Q and NSRAS • Includes 8 risk categories, each rated independently

  19. SIRA Categories • Mobility/Activity • Sensory Perception • Friction/Shear • Moisture • Tissue Perfusion & Oxygenation • Devices • Postmenstrual Age (if applicable) • Weight

  20. Mobility/Activity

  21. Sensory Perception

  22. Friction/Shear Shear Friction

  23. Moisture

  24. Tissue Perfusion & Oxygenation

  25. Devices

  26. Postmenstrual Age

  27. Weight

  28. Skin Integrity Risk Assessment • Patient assessment findings are ‘at risk’ or ‘not at risk’ utilizing the nomenclature in the tool • No need for ‘scoring’ or identifying a threshold for risk • Used within the electronic health record to guide pressure ulcer prevention interventions through assisting documentation of assessment and care planning. • Planned patient interventions are visible in the electronic nursing assessment documentation

  29. SIRA meets PHRED!

  30. Nursing Documentation

  31. Individualized Plan of Care

  32. References • Baharestani, M.M. & Ratliff, C.R. (2007). Pressure ulcers in neonates and children: An NPUAP white paper. Advances in Skin & Wound Care, 20(4), 208, 210, 212, 214, 216, 218-220. • Bergstrom, N., Braden, B.J., Laguzza, A., Holman, V. (1987). The Braden scale for predicting pressure sore risk. Nursing Research, 36(4), 205-210. • Curley, M.A.Q., Quigley, S.M., & Lin, M. (2003). Pressure ulcers in pediatric intensive care: Incidence and associated factors. Pediatric Critical Care Medicine, 4, 284-290. • Curley, M., Razmus, I., Roberts, K., Wypij, D. (2003). Predicting pressure ulcer risk in pediatric patients: the Braden Q Scale. Nursing Research, 52(1), 22-33. • Huffines, B., Logsdon, M.C. (1997). The neonatal skin risk assessment scale for predicting skin breakdown in neonates. Issues in Comprehensive Pediatric Nursing, 20, 103-114.

  33. References • Moore, Z.E., Cowman, S. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews 2008, 16(3): CD006471. • Noonan, C., Quigley, S., & Curley, M. (2006). Skin integrity in hospitalized infants and children: A prevalence survey. Journal of Pediatric Nursing, 21(6), 445-453. • Pancorbo-Hidalgo, P., Garcia-Fernandez, F., Lopez-Medina, I., & Alvarez-Nieto, C. (2006). Risk assessment scales for pressure ulcer prevention: A systematic review. Journal of Advanced Nursing, 54(1), 94-110. • Quigley, S., Curley, M. (1996). Skin integrity in the pediatric population: preventing and managing pressure ulcers. Journal for Specialists in Pediatric Nursing, 1(1), 7-18. • Willock, J., Baharestani, M.M., Anthony, D. (2009). The development of the Glamorgan paediatric pressure ulcer risk assessment scale. Journal of Wound Care, 18(1), 17-21.

More Related