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TIME TO START PROJECT

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TIME TO START PROJECT

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    1. TIME TO START PROJECT QNIS CONFERENCE 5TH MARCH 2008

    3. BACKGROUND Nursing Home Medical Practice Expenditure on wound care products Watret (2007) & Bruce (2007) Challenges faced by Care Home Staff in providing initial wound care & Empowering staff. Questionnaire to CHS Similar projects Overview of cost in care homes from seminal piece of work by watret and bruce notes Overall cost of care home. Education. Continuity, equity of care How much spend – rachels notes compare prisms, CHCP and care home types of dressings (article)Overview of cost in care homes from seminal piece of work by watret and bruce notes Overall cost of care home. Education. Continuity, equity of care How much spend – rachels notes compare prisms, CHCP and care home types of dressings (article)

    4. WOUNDS ENCOUNTERED Pretibial haematomas and lacerations Pressure / leg/ diabetic foot ulcers Incontinence Dermatitis Minor Trauma

    5. AIMS & OBJECTIVES Aim of study To provide equity of care for the patient in the management of complex and superficial wounds regardless of their health care setting Objectives To promote best practice in wound management To provide a framework to promote continuity of care To promote a cost effective approach to wound management

    6. METHODOLOGY Funding 6 month pilot 13 Nursing Care Homes Provision of stock of dressings for use as initial dressing Structured Education sessions TIME framework Resource folder Audit form Ongoing support COPY OF RESOURCE FOLDERCOPY OF RESOURCE FOLDER

    7. What is T.I.M.E? An approach to wound assessment T – tissue type I- infection/inflammation M- moisture balance E- edge of wound International advisory board on wound bed preparation (Schultz, 2003)

    8. RATIONALE FOR DRESSING CHOICE Knowledge of commonly encountered wound types in care home setting Fit for purpose Should do no harm Familiarity Promote equity & consistency Project team’s clinical expertise and experience Evidence base Availability

    9. Dressings Atrauman 7.5 x 10cm Inadine 9.5cm x 9.5cm Intrasite gel 8g Aquacel 10 x 10cm Alldress 15cm x 15cm Opsite Plus 12cm x 10cm Duoderm extra thin 10cm Allevyn 10cm x 10cm K Soft 10cm x 3.5m Crepe bandage (Profore 2) 10cm x 4.5m Scanpor tape 2.5cm x 5m Sodium Chloride 0.9% (steripod) 20ml Cavilon cream sachet (2g) Topper 8 non woven fabric swabs 7.5cm x 7.5cm Leukostrips (3) 6.4cm x 76mm

    11. INCLUSION CRITERIA An existing resident who develops a new wound A new resident who is admitted to the home with a wound and has no dressings or has dressings which are considered by the nursing home staff to be inappropriate

    12. EVALUATION /FINDINGS 5 KEY ELEMENTS Analysis of audit forms Wound product usage Prescribing practice Post pilot questionnaire Expenditure

    13. AUDIT FORMS WOUND TYPE

    14. Did dressing meet initial wound care needs?

    15. 2. WOUND PRODUCT USEAGE Discuss – mismatch. Relatively few more expensive /complex wound dressingsDiscuss – mismatch. Relatively few more expensive /complex wound dressings

    16. 3. PRESCRIBING PRACTICE Awaiting further analysis. A few used box 2-3 times then no further scripts etcAwaiting further analysis. A few used box 2-3 times then no further scripts etc

    17. 4. POST PILOT QUESTIONNAIRE 80% (n=8) stated that the project met their patients’ needs 90% (n=9) stated that the project resulted in treatment being started prior to a prescription being raised 50% (n=5) stated that the project had prevented the need to keep an excess stock of dressings 90% (n=9) agreed that the products provided were appropriate to their patient group The resource folder was felt to be a useful educational tool for 50% (n=5) 100% responded that they would recommend the project to other care homes 90% would continue to participate in the project if this was offered More concise! Maybe just highlighted bits & discuss restMore concise! Maybe just highlighted bits & discuss rest

    18. 5.EXPENDITURE

    19. Discussion Enthusiasm from care home staff Identified potential areas for further research and education Problems in completion of audit forms Dressing choice Cost effectiveness

    20. THE FUTURE Recommendations Further analysis of prescribing activity Roll out to all NHMP care homes Support of the newly formed care home liaison nurse team. Reduce range of dressings Ensure product selection is in concordance with the Wound Care Formulary soon to be widely implemented across NHS Greater Glasgow & Clyde Dissemination of results at Clinical Governance event. Publication of results

    21. AIMS & OBJECTIVES Aim of study To provide equity of care for the patient in the management of complex and superficial wounds regardless of their health care setting Objectives To promote best practice in wound management To provide a framework to promote continuity of care To promote a cost effective approach to wound management DO you think we met our objectives? Yes some. But bigger mountains to climbDO you think we met our objectives? Yes some. But bigger mountains to climb

    22. PROJECT TEAM Liz McLure - District Nurse Rachel Bruce - Pharmacist NHMP Lynne Watret- Tissue viability CNS Primary care Isobel Baxter - Clinical effectiveness Jamie Quin - Clinical Services Manager Liz McClusky – Pharmacy technician Janice Bianchi –Tissue viability lecturer GCU For futher information, contact Liz McLure liz.mclure@nhs.net

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