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Championing skin integrity

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Want to become involved in helping the elderly look after their skin? This article is a first step toward becoming a champion of skin integrity. 

In managing and caring for skin injuries, there is now substantial documentation to prove that evidence-based wound management is making a world of difference in aged care.

Residential aged care facilities (RACFs) now have the opportunity to participate in a national dissemination and implementation of the Evidence Based Champions for Skin Integrity (CSI) program and associated resources.

The program and resources were first developed in 2008–10 as part of the Department of Health and Ageing’s Encouraging Better Practice in Residential Aged Care (EBPRAC) program.

This first stage of the CSI Program was implemented and evaluated by a consortium of seven RACFs across Qld and NSW and the School of Nursing, Queensland University of Technology, led by professor Helen Edwards, program leader for the Cooperative Research Centre for Wound Management Innovation.

The impetus for the project was the recognition of the increased incidence of wounds in older adults, the significant pain and decreased quality of life caused by chronic wounds, and the burden on carers and health system resources aggravated by evidence-practice gaps in appropriate assessment and timely use of best practice treatments.

While there are a large number of evidence-based guidelines addressing differing aspects of wound management and/ or different types of wounds, very few guidelines cover all aspects of wound management.

This contributes to the difficulties faced by clinicians trying to quickly locate appropriate evidence based information on wound care, exacerbated by the multiple guidelines available on the same types of wounds, increasing confusion for clinicians and carers in deciding which to follow.

To address this, the project team developed a suite of guidelines summaries which provided a simple summary and consistent rating of evidence based guidelines from multiple documents. The guidelines’ recommendations were grouped into assessment, management and prevention sub-headings.

Following this, all education and resources for the project were based on these summary documents.

The aim of the project was to preserve skin integrity and increase implementation of evidence-based wound management through implementing the CSI Model in RACFs, where the incidence of skin tears, pressure ulcers and chronic leg or foot ulcers are a serious issue.

This model incorporated multiple evidence-based strategies for promoting the uptake of evidence into practice, including: a supportive environment with local Champions, easy access to education and information resources, use of audit and feedback cycles, hands on skills development and clinical decision making support systems.

The initial audit and feedback cycles found a significant decrease in the prevalence and severity of wounds following implementation of the CSI model, particularly in the area of pressure injuries. The figures indicated that the CSI model was able to facilitate the implementation of evidence-based prevention and management strategies, with positive outcomes.

There has been overwhelming demand for access to the project resources, with requests received from many organisations across Australia and overseas, including residential aged care facilities, community nursing associations; hospital in the nursing home programs, GP practice nurses, and the acute care hospital sector.

The success of the first stage in increasing implementation of evidence-based wound management and developing an evidence based resource kit has highlighted the value of strategies which focus on stakeholder involvement and a focus on prevention.

These strategies have the potential to improve the quality of life of people with, or at risk of developing chronic wounds, while also reducing the burden on their carers.

In addition, and of considerable importance in the current climate of the strain being experienced by the Australian aged care sector, is the potential reduction of the burden on health system resources.

As a result of evaluations and discussions, it was concluded that the dissemination of the CSI Model and project resources on a national scale would be beneficial. The project team will soon extend an invitation to all RACFs across Australia to participate in the dissemination of the project and resources throughout 2013 and 2014.

The pivotal requirement would be to identify a clinical leader with strong commitment to supporting dissemination and implementation of evidence-based practice in skin integrity and wound care, to become a Champion and CSI trainer.

This Champion would be given the opportunity to attend a “train the trainer” workshop given by the project team on the CSI Model and use of the resource kit, with the expectation that skills and knowledge acquired at the workshops would be used to train a team of Champions within their RACF, lead a small project on evidence based wound care, and engage with the project team in the few months following the workshops to provide feedback on the project activities.

It is envisaged that the Champion and their new team of CSIs would act as a resource person for advice and be the first point of contact to contribute to education and change management strategies for promoting evidence-based wound care.

This might seem like a daunting prospect, and might well be – were it not for the support provided for Champions.

This includes a comprehensive resource kit, with evidence based guidelines summaries; brochures for health professionals, clients and carers; tip sheets; flow charts; a self-education DVD, with eight modules, self-assessment quizzes and all resource files; a wound dressing information guide; role descriptions for Champions at all levels; role descriptions for wound care networks and link clinicians; a data collector (clinical auditor) training file; skin integrity audit tool; support tools for meetings and education, with template files (e.g. evaluation tools, fact sheets, discussion group resources); and link information to sources of evidence based guidelines in wound management.

In addition workshops will provide guidance on change management strategies, targeted goal setting activities, and formation of long-term support networks.

Dr Kathleen Finlayson is a research fellow at the Faculty of Health at Queensland University of Technology and can be contacted at [email protected]

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