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2009 Clinical Excellence Commission Award
Award Winner
Pressure Ulcer Prevention - a Crystal Solution
Hunter New England Area Health Service
Pressure ulcers are painful, costly and a key indicator of quality nursing care (Angel et.al 2004). Evidence indicated that patients continued to develop pressure ulcers within Hunter New England Health (HNE Health) facilities and required transfer to community care. In response, the Crystal Model of change management was developed to identify and interconnect eight components pivotal to the prevention of pressure ulcers. These are: Policy, Surveillance, Equipment, Communication, Documentation, Wound Management, Education and Paediatrics.
Point Prevalence Surveillance (PPS) was conducted on adult inpatients to inform strategies within each component. Cost savings were realised following implementation of mattress replacement guidelines and an equipment algorithm. A repeat survey at a pilot site together with a patient’s experience illustrated significant improvement in recognition of high risk patients and reduction in prevalence of pressure ulcers.
Finalists for this award
Alcohol handrub on the foot of the bed: a simple solution
South Eastern Sydney Illawarra Area Health Service
Poorly practised hand hygiene by healthcare workers has long been recognised as the major cause of hospital-acquired infections. Perceived barriers to adherence include time taken to clean hands and difficulty accessing hand cleansers. Recognising relatively high rates of serious infections at our hospital, we reasoned that simply placing alcohol handrub where it was needed – on the end of the patient’s bed – would increase usage and reduce the rate of Staphylococcus aureus bloodstream infections (SABs). Without additional education, alcohol handrub usage rates more than doubled in a year and the SAB rate almost halved, likely saving six lives. Making handrub usage and infection rate data routinely available to staff at networked hospitals led to a rapid uptake of the initiative elsewhere.
Delirium: Day to day business for one in five patients
Northern Sydney Central Coast Area Health Service
Delirium is experienced by one in five elderly inpatients at any point in time within the Northern Beaches Health Service (NBHS). This often preventable clinical condition results in sub optimal clinical outcomes and dissatisfaction with health care services. Medical record audits for patients with delirium indicated a large variance in clinical practice from published evidence based guidelines. A clinical redesign project was conducted to embed a systemised approach to screen, diagnose and appropriately manage delirium in the elderly across all clinical areas.
Evaluation indicates:
- 30% improvement in accurate diagnosis
- Improved clinical management and discharge outcomes including 26% reduction in length of stay
The project team is now working towards transferring this model into the community setting and sharing lessons learnt with other hospitals.
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