March 3, 2021

Skin and Pressure Injury Assessment enhancements in the EMR

The Skin and Pressure Injury Assessment in the EMR has been enhanced to assist clinical staff in conducting Skin and Pressure Injury Assessments and to ensure Western Health is in line with best practice.  These changes are detailed below.

For further information please contact Kylee Ross, Assistant Chief Nursing & Midwifery Informatics Officer – kylee.ross@wh.org.au or Anna Novak, Acting Allied Health Manager, Podiatry – anna.novak@wh.org.au

 

Change 1. Changes to the nomenclature for Skin Assessment.  Available fields for Skin Assessment will be:
• Localised Heat
• Oedema Present
• Localised Pain
• Induration Present
• Non Blanching Erythema

 

Change 2.  Changes to nomenclature for Skin Integrity.  Available fields for Skin Integrity will be:

  • Skin intact (no Pressure Injury or wounds present on skin)
  • Blanching Erythema (present)
  • Non-Blanching Erythema (present -stage 1 PI)
  • Moisture/Incontinence assoc. Dermatitis (Incontinence associated dermatitis or Moisture associated dermatitis present)
  • Other (other wound type present – see wound chart for details)

 

Change 3. When Blanching Erythema, Non-blanching Erythema or Other are selected (see above), an additional field will appear asking if IPOC and Wound Chart Commenced.

 

Change 4.  When the answer is Yes to IPOC and Wound Chart Commenced, the field Riskman Completed will appear.

 

Change 5. When the answer is No to IPOC and Wound Chart Commenced, then Reason Not Commenced will appear.

 

Change 6.  A new field has been included in the fields for Automatic high Risk – Pressure Injury.

  • Clinical Assessment indicates High Risk of PI (Clinical assessment indicates patient at risk of developing a Pressure Injury)

 

Change 7.  The Skin & pressure Injury Risk Category has moved to the end of the assessment ‘to summarise’.

 

March 3, 2021

Skin and Pressure Injury Assessment enhancements in the EMR