Applying QIPP to Ageing skin

Transcription

1 Applying QIPP to Ageing skin E45-UK Dec 2010 Dr. Edward Vining PhD BPharm MRPharmS

2 Applying QIPP to Ageing Skin Normal skin and barrier function Pathophysiology of ageing skin Complications Considerations Prevention What is QIPP? Applying QIPP solutions Summary

3 Normal Skin and Barrier Function 1. From; The management of skin conditions. CPPE 2007

4 Skin Structure 1. From; The management of skin conditions. CPPE 2007

5 Elderly Skin Pathophysiology With ageing comes a 20% loss in dermal thickness 2 Epidermal cells become thinner making the skin look noticeably thinner Changes in the epidermis allows more fluid to escape the skin The rete-ridges of the dermal-epidermal junction flatten out making the skin more fragile and making it easier for the skin to shear. This process also decreases the amount of nutrients available to the epidermis by decreasing the surface area in contact with the dermis = slower repair/turnover 2 2. Skin ageing and its treatment. Bauman. L J Pathol 2007; 211:

6 continued These changes cause the skin to wrinkle and sag. The dermal layer thins 2 Less collagen is produced 2 The elastin fibers that provide elasticity wear out function of sebaceous & sweat glands contribute to dry skin 4 The fat cells get smaller 4 This leads to more noticeable wrinkles and sagging Cushion of fat reduced (shock absorber to trauma) 4. Skin tears; A review of the evidence to support prevention and treatment. Ratliff et al. Ostomy wound management 2007;

7 Complications Tears are common 3 Dry skin (xerosis) 4 Asteototic eczema 4 Ulcers 4, 5 Chronic itching (pruritis) 4 Bruising 4 Difficulty in application, reach 6 Heat loss 7 3. Skin tears; A review of the evidence to support prevention and treatment. Ratliff et al. Ostomy wound management 2007; Dermatology- An Illustrated colour text 2 nd edition- Gawkrodger. D Pressure sores in elderly patients the epidemiology related to hip operations. Versluysen. From St Bartholomew s Hospital, London Eczema in the elderly. Bryden Heat-Related Illness in the Elderly. Allen. A et al. July

8 Pressure Ulcer Stages

9 Morbidity & Mortality Pain Infection Quality of life Death Cost

10 Impact of Risk Assessments Implementation of risk assessment reduced development of new pressure ulcers each year in one hospital 18.7% 13.1% 11.7% 6.4% Source: Bergstrom N. Nurs Clin North Am 1995;30:

11 Impact of Risk Assessments Implementation of Braden scale reduced new pressure ulcers over 6 months in high risk patients 32.6% 9.1% Source: Horn., Clinical Practice Improvement. Faulkner & Gray Inc. 1994

12 Considerations Scratching 3 Lifting/moving 8 Ambulatory stays 5 Tapes and adhesive dressings 9 Low object at shin height 8 Hard edges on trolleys 8 Soaps 8 Bathing 8 Moisturisation of skin 3 3. Skin tears: A review of the evidence to support prevention and treatment. Ratliff et al. Ostomy wound management Best Practice Recommendations for the Prevention and Treatment of Skin Tears. Le Blanc et al. Wound care Canada 2008 (6) Skin tear prevalence and management at one hospital McErlean B et al. Primary intention Vol. 12 No. 2 May 2004

13 Prevention Review risk factors patients eg. Neuropathy, disability, cognitive impairment, diabetes Carer education e.g. lifting Use of non soapy soaps Emollients* (xerosis and eczema. See next slide) Drag sheets Patient education Nutrition- fluid intake Review medication, corticosteroids Equipment, bed rails, wheelchairs 3. Skin tears: A review of the evidence to support prevention and treatment. Ratliff et al. Ostomy wound management Best Practice Recommendations for the Prevention and Treatment of Skin Tears. Le Blanc et al. Wound care Canada 2008 (6) Skin tear prevalence and management at one hospital McErlean B et al. Primary intention Vol. 12 No. 2 May 2004

14 Plan of Care to Address Risk Factors Skin Care Pressure Reduction Incontinence Care Nutritional Interventions

15 General Skin Care Daily skin inspections for high-risk individuals Skin cleansing Minimize drying & cracking Minimize excess moisture Avoid massage

16 Emollient action- 1. From; The management of skin conditions. CPPE 2007

17 What is QIPP? Quality, Innovation, Productivity and Prevention At the heart of DoH plans to reduce NHS inefficiencies while improving quality of care Workstreams Leads and supports NHS staff driven reform 10.

18 QIPP Workstreams Safe Care Long Term Conditions Right Care Urgent and emergency care End of life care Medicines Use and Procurement Technology and digital vision Procurement Productive care Back office functions Primary care Clinical Support Services 11. Adapted from

19 Safe Care-The workstream will offer the NHS: Working with NHS staff the workstream aims to achieve: 80 percent reduction in hospital acquired pressure ulcers (grade 3-4) 30 percent reduction in community acquired pressure ulcers (grade 3-4) 50 percent reduction in catheter-acquired urinary tract infections 25 percent reduction in falls in care

20 Long Term Conditions-The workstream will offer the NHS: The workstream will deliver a national support and improvement programme that will support local geographic areas to implement a generic model for supporting patients with LTCs based on 4 key principles: Commissioners understanding the needs of their population and managing those at risk to prevent disease progression Empowering patients to maximise self-management including ensuring patients have a care plan and appropriate information and knowledge about how to manage their condition. Providing joined up and personal services particularly in community and primary care and working closely and effectively with social care. Strong professional and clinical leadership and workforce development.

21 Medicines use and procurement- The workstream will offer the NHS: Clear guidance on the efficient use of medicines in primary care through the National Prescribing Centre and review / expansion of existing Better Care Better Value indicators Greater transparency and clarity to commissioners and prescribers on the cost of some treatments for example specials Best practice tool on medicines management and additional support for Primary Care Trust Prescribing advisers Additional proposals to improve medicines waste and concordance

22 Applying QIPP solutions Safe care- need to reduce incidence of ulcers acquired in community and hospital LTC- patient empowerment and care close to home, standards of care, risk factors Medicines management- education on products and use, right products, polypharmacy, emollients and use

23 Summary Age leads to reduction in skin integrity Reduction in barrier nature of skin can lead to complications Prognosis? Ulcers/tears lead to reduced quality of care, patient pain and discomfort, extended bed residence times, expensive dressings, more nursing care Infections Simple measures and risk assessment QIPP