Model of Care for Prevention and Integrated Management of Pressure Injuries in People with Spinal Cord Injury and Spina Bifida
The Model of Care for Prevention and Integrated Management of Pressure Injuries in People with Spinal Cord Injury and Spina Bifida (PI MoC) developed by the State Spinal Cord Injury Service (SSCIS) was launched at the Clinical Excellence Commission Pressure Injury Prevention Project Launch held at the Mint on the 25 March 2014.
The PI MoC focuses on health promotion and early intervention to maintain health status and/or reduce the extent and number of PIs in people with SCI/SB. It incorporates features of the Chronic Care Model, different levels of primary, secondary and tertiary prevention; the concept of risk stratification for health promotion with self-management support and early risk assessment, clinical decision support and care coordination with increasing levels.
In doing so it aligns with the NSQHSS Standard 8 and supports the Clinical Excellence Commission (CEC) Pressure Injury Prevention & Management Policy though primarily targeting the individuals in the community and the care and primary health care services supporting them.
The six recommendations outlined below have been developed for the implementation of a consistent approach to pressure injury prevention and management in the individual with SCI/SB. They have been informed by the body of evidence and key findings resulting from the project, guidance from the project Steering Committee, and Health Economics Analysis of data provided by the NSW Health Centre for Epidemiology and Evidence (CEE).
The recommendations are as follows:
- Provide decision support systems to enable people with SCI/SB, carers and clinicians to access information, expertise and tools to support prevention and appropriate management of PIs.
- Provide timely access to care and equipment to prevent PIs or promote healing of them.
- Develop systems and processes that facilitate integrated care with effective communication between the person with SCI/SB, health care and service providers across sectors.
- Develop systems and processes that facilitate self-management and enhance psychosocial support to the person with SCI/SB and their primary carers.
- Develop multilayered educational strategies for PI prevention and management applicable to the person and all stakeholders across the phases of care.
- Integrate clinical information and data management systems for care coordination, monitoring and outcome evaluation.
Implementation plan and priorities include:
- Development of online decision support tool with triage/referral pathways, clinical practice guidelines, risk assessment tools, coordinated care plan, website educational resources.
- Working with Local Health Districts/Networks to:
- Identify ‘local champions’ and map local services and referral patterns/processes.
- Define and test ‘best practice’ clinical pathways in 1-2 Local Health Districts, and through the process produce a guide for others.
- Develop strategies to ensure timely access to wound products, equipment and care to prevent PI and/or their deterioration.
- Investigate opportunities to facilitate communication through use of person controlled electronic health record (PCEHR), clinical information systems and the use of health technology (video/teleconference, digital photography, internet, social media)
- Facilitate self-management support and development of staff/peer mentor training in motivational coaching techniques.
- Enhance psychosocial support through comprehensive psychosocial needs assessment, clinical psychology interventions and peer involvement.
- Promoting timely access to care and equipment through a whole of government / inter-sectoral approach.
- Develop a multi-layered educational strategy.