ABSTRACT
Objectives: The aim of the study was to explore the impact of a healthy skin and wound prevention programme by measuring nursing staff knowledge and patient wound prevalence in the Intensive Care Unit (ICU) pre and post intervention. A secondary aim was to identify the impact of the education and implementation program on pressure injury (PI), skin tear (ST) and incontinence associated dermatitis (IAD) prevalence and incidence rates in the ICU. Methods: A prospective quality improvement project based on the plan-study-do-act methodology included three phases: 1. Pre-Intervention Data Collection (December 2020) - Wound Prevalence Survey (full body skin inspection) & Staff Knowledge Quiz 2. Intervention Phase -- Staff Education, Evidence Based Protocol Implementation & Evidence based products available in units 3. Post-Intervention Data Collection - Wound Prevalence Survey (full body skin inspection) & Staff Knowledge Quiz Results: Pre-intervention data demonstrated two thirds of ICU patients had one or more wound. ICU Pressure Injury prevalence was 37.5%, IAD prevalence 12.5% and ST prevalence was 4%. ICU PI incidence reporting rate was 11%. Device Related PI rate was 56% of all PIs identified. Staff knowledge about wound prevention averaged 50%. Conclusions: As a result of the Covid-19 surge, post implementation data will be collected in May 2022 and the data will be presented as comparative outcomes.
ABSTRACT
Background: Foot infections in persons with diabetes is a significant detriment to the patient and accounts for approximately 27,600 hospital admissions every year in Australia. To our knowledge, there is scant data from large datasets reporting on clinical outcomes for foot infections in persons with diabetes (DFIs). Aim: The primary aim is to report the number of DFI episodes and their associated clinical outcomes. Methods: The South West Sydney Limb Preservation and Wound Research Academic unit established a clinical registry in Liverpool Hospital High Risk Foot Service in 2018. All data is entered prospectively into REDCap. Infection presentations to the High-Risk Foot Service are captured and entered in terms of an infection episode, hence one patient may have multiple episodes of infection. Data recorded on REDCap is extensive and includes broad demographic, laboratory and clinical data, in addition to all outcome data. In order to capture the increased activity of COVID-19 we plan to have a cut off period as of June 2022 for full data extraction and analysis. Results: We will report clinical outcomes of interest separately for skin and soft tissue DFI and Osteomyelitis, and stratify infections based on the PEDIS infection grade and severity. Outcome data will include the number of DFI episodes and their outcome;infection resolution, infection failure, % of episodes medically managed, the % of episodes requiring surgery [minor or major amputation, resection, and debridement], duration and type of antibiotic therapy, death. Conclusion: The full data set will be available by the conference presentation and currently includes >400 infection episodes and outcomes. To the best to our knowledge there is no single prospective database as large from > 4 years of collection, reporting on infection outcomes for those with diabetes and foot disease.
ABSTRACT
Background: SARS-COV-2 (COVID-19) pandemic was accompanied by public health orders placing restrictions on healthcare and social systems. Most out-patient based services and GP practices closed face-to-face appointments and transitioned to telehealth. Liverpool High Risk Foot Service (LHRFS) remained functionally open but utilised the Australian clinical triage guide for people with diabetes-related foot disease during COVID-19. Only patient's considered 'highly serious' or 'critical' (i.e. infections' or limb threatening condition) were seen face-to-face. Over this period we anecdotally recognised a significant increase in presentations for Diabetes foot Infections (DFIs). Methods: The South West Sydney Limb Preservation and Wound Research Academic unit established a clinical registry in 2018. All data is prospectively entered into REDCap including demographic, laboratory, outcome and clinical data. Infection presentations to the HRFS recorded in terms of an infection episode, hence one patient may have multiple events of infection. In order to capture the increased activity of COVID-19 we plan to collect from 2020 through June 2022. Pre-COVID data will be from 2018 to early 2020. Results: We will report the number of DFI events by month and year for 2018-2022 and analyse trends of COVID restrictions to determine if this affected the number and severity of DFI events. Conclusion: COVID-19 public health orders limited access to care. We will conclude if this affected people with foot ulcers accessing timely care and if this caused an increase in the number of infections.
ABSTRACT
Objectives: To evaluate the usability and effectiveness of a digital application for wound care from a clinician-and-patient user perspective. Methods: A quasi-experimental design was conducted in four settings in an Australian health service from July to December 2019 to October 2020. Owing to the coronavirus disease pandemic, the study paused in March 2020 but then restarted immediately after 3 weeks. Data were collected from patients in the standard group (n = 166, 243 wounds), and intervention group (n = 124, 184 wounds). Clinicians participated in a survey (n = 10) and focus group interviews (n = 13) and patients were interviewed (n = 4). Wound documentation data were analysed descriptively. Interviews were thematically analysed. Results: Positive evaluations identified improvements such as instantaneous objective wound assessment, shared wound plans, increased patient adherence and enhanced efficiency in providing virtual care. Compared to the standard group, wound documentation in the intervention group improved significantly (more than two items documented 24% versus 70%, p < .001). During the intervention, 101 out of 132 wounds improved (mean wound size reduction = 53.99 %). The travel-related fuel cost saved for a patient living in a rural area was on average $72.90. Conclusions: The digital application provided real-time wound data with an interface for communication between the patient and clinician and clinicians in a hospital, community, and outpatient setting in a variety of settings. The use of the application facilitated remote patient monitoring, and reduced patient travel time, while maintaining optimal wound care.