Prevention of Pressure Injury among Persons with Spinal

Prevention of Pressure Injury among Persons with Spinal Cord Injury A Systematic, Educational, Interdisciplinary Approach Hanne Haugland, Anne Risøen Selsjord and Ingebjørg Irgens Sunnaas Rehabilitation Hospital

Declaration of Financial Interests or Relationships Speakers‘s names: Hanne Haugland, Anne Risøen Selsjord and Ingebjørg Irgens We have no financial interests or relationships to disclose with regard to the subject matter of this presentation. EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 2

Outline 1. 2. 3. 4. 5. Sunnaas Rehabilitation Hospital Interdisciplinary team work Development of an educational program for PI follow- up Results The Future. . EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 3

Sunnaas Rehabilitation Hospital • Interdisciplinary rehabilitation to patients with complex functional impairment following illness or injury Severe multi trauma, traumatic brain injury, stroke, cognitive challenges, pain, severe burn injury, neurological illnesses, congenital disorders and Spinal cord injury (Lifelong follow- up responsibility)and • Focus on community re-entry Include the patient as an active participant in their own treatment, surrounded by a Interdisciplinary team EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 4

EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 5

24: 7 responsibility The National Patient Safety Program (TNPSP) in Norway was established with the aim to • Diminish inpatient injury and damage • Establish a long- term strategy for patient saftey • Improve the patient safety culture in the health care service Regarding pressure injury risk, TNPSP recommends 3 questions; 1. Present PI at admission? 2. Independent reposition possibility? 3. Is the patient at risk of PIs? EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 6

Developing an interdisciplinary educational program 16 % 9% 20 % Start Future EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 7

Developing an interdisciplinary educational program 16 % 9% 20 % Start Future Pilot Outpatient Interdisciplinary Wound team EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 8

Developing an interdisciplinary educational program 16 % 9% 20 % Start Future Pilot Outpatient Interdisciplinary Wound team EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 9

Developing an interdisciplinary educational program 16 % 9% 20 % Start Future Pilot Outpatient Interdisciplinary Wound team EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 10

Developing an interdisciplinary educational program 16 % 9% 20 % Start Future Pilot Outpatient Interdisciplinary Wound team Phd Innovation projects EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 11

Developing an interdisciplinary educational program Booklets E- learning courses Webinar Videos 16 % 9% 20 % Start Future Pilot Outpatient Interdisciplinary Wound team Phd Innovation projects EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 12

Developing an interdisciplinary educational program Booklets E- learning courses Webinar Videos 16 % 9% 20 % Start Future Pilot Outpatient Interdisciplinary Wound team Phd Innovation projects Wound Competency Group EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 13

Developing an interdisciplinary educational program Booklets E- learning courses Webinar Videos 16 % 9% 20 % Flap- surgery follow- up Start Future Pilot Outpatient Interdisciplinary Wound team Phd Innovation projects Wound Competency Group EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 14

. . . and recurrence risk after flap- surgery WHY • Increased risk of recurrence afte flap surgery (30 - 40 % in • Necessary with education to the patients and the local home care givers regarding – Restrictions – Transfer guidance – What to observe, red flags HOW • 2 years follow- up after the surgery, – Telephone, – Picture transfer (APP = encrypted channels), – Video conference (encrypted channels) AIM – continuity in the follow- up, – be a cooperator regarding the local caregivers, – A professional support – Discover red spots at earliest, possible stage. EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 15

The patients and the local care givers report increased safety and continuity in the follow- up Citation from a patient: “I learn a lot from being present when they discuss my wound” Citations from the home care nurses: “This follow-up creates greater safety for us as a career, and also for the user”. “Important to get information and training”. “We find the offer reassuring. Good to get better skills, Good to know we can ask. We have the opportunity to make changes faster”. EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 16

Contacts 2012 - 2019 1000 900 800 700 600 500 400 300 200 100 0 In 2012 In 2018 EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens In 2019 17

Wound severity From 80 % to 30 %, grade 3 and 4 pressure injuries Changes in wound severity 2012 -2018 120 100 80 60 40 20 0 EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 18

Recurrence after flap- surgery, 2014 - 2019 12 10 8 6 4 2 0 In 2014 In 2015 In 2016 In 2017 Series 1 In 2018 In 2019 Series 2 EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 19

The future ü ü ü Identify patients who are excluded from the follow- up program Closer monitoring of patients with a newly aquired injury Establish use of new, technical solutions (Spectum, the Pic. App) Establish even better tools for safe and secure communication Establish a smarter loop between the e- health communication tools and the electronic patient journal system EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 20

Thanks for your attention EPUAP, Lyon 2019 Hanne Haugland, Anne Selsjord, Ingebjørg Irgens 21