skin assessment) within 8 hours of presentation to your facility? Check the eMR, progress notes, clinical notes or other nursing discharge summary’s for this information. The time of admission should be available from the eMR, admission summary sheet or similar. 21351 Single Choice Q5. Is there documentation of the person receiving one element of the comprehensive risk assessment? A fully completed comprehensive skin assessment within 8 hours of presentation to your facility A fully completed risk assessment using a validated tool within 8 hours of presentation to your facility The person received neither of the above If The person received neither of the above, jump to question no: 8 Select The person received neither of the above when neither a fully completed validated pressure injury risk assessment tool has been documented NOR a fully completed skin assessment that is based on visual inspection has been documented. If one or the other has been completed select the appropriate answer 22697 Single Choice Q6. At the initial risk assessment (within 8 hours of presentation to the facility) was the person? Not at risk of pressure injury At risk of pressure injury An initial risk assessment is not documented for this person if Not at risk of pressure injury, jump to question no: 12; if An initial risk assessment is not documented for this person, jump to question no: 8 If the person received a comprehensive risk assessment within 8 hours of presentation select Not at risk or at no risk of pressure injury or At risk of pressure injury. If the person did not receive an initial risk assessment within 8 hours of presentation to the facility choose An initial risk assessment is not documented for this person. 11540 Matrix Q7. At the initial risk assessment (within 8 hours of presentation to the organisation) which tool was used and what was the risk category? See the table below Select one of the risk category answer options for the risk assessment tool used during the initial risk assessment. Indicate the risk assessment tool used and the person’s level of risk identified using that tool.
prevention plan for the person? Check the care plan, the eMR, progress notes or clinical notes for this information. 22772 Compliance Q10. Is there documentation in the healthcare record of fully completed comprehensive risk reassessment (using a validated tool and comprehensive skin assessment) on each of the last 3 days? Yes No N/A Check the patient’s records for the last three days. Select No if there is no skin assessment and risk assessment documented for each 24 hour period. If the initial risk assessment is within the last three days then consider if there is documented reassessment of the person’s risk on each day. E.g. Patient has been on the ward for two days and both the initial and daily assessment have been completed select Yes. Select N/A if the patient is not currently identified as ‘at risk’ of pressure injury. 10385 Compliance Q11. Is there documentation of information on the prevention of pressure injury being provided to the person or their carer? Yes No Yes can only be selected if documented in the clinical record/care plan that information has been provided. 22773 Single Choice Q12. Is a pressure injury or injuries documented within the last three days? Yes No Check the care plan, the eMR, progress notes or clinical notes for this information. 21168 Single Choice Q13. Is there documentation of the person being incontinent? Urinary incontinence Faecal incontinence Both faecal and urinary incontinence Catheterised with leakage Catheterised without leakage Check the care plan, the eMR, progress notes or clinical notes for this information.
23087 Single Choice Q22. Can the person independently reposition in the bed and the chair? Yes No If the person requires assistance to reposition, the response is No The survey team can either ask the patient directly or consult with the clinical staff caring for the person to determine if the person can independently reposition. You can also check the eMR, progress notes, clinical notes or ICU nursing discharge summary for this information. 23085 Single Choice Q23. What mattress is the person using at the time of the survey? Basic hospital mattress or standard foam Reactive (constant low pressure) non – powered high density foam or memory foam mattress Reactive (constant low pressure) non-powered gel mattress Reactive (constant low pressure) non-powered air mattress Reactive (constant low pressure) non-powered combination mattress Reactive (constant low pressure) powered low air loss mattress Reactive (constant low pressure) powered other reactive mattress Active powered alternating air overlay Active powered alternating air mattress replacement Equipment ordered Other The person refused equipment Not applicable The survey team should inspect the mattress type used by the person while conducting the skin inspection on the day of the survey and choose the mattress type identified in the list that is closest to that being used by the person.. < The organisation should provide additional local information on the mattress types used locally and the corresponding mattress type identified in the survey responses > 23086 Single Choice Q24. What seating is the person using at the time of the survey? Basic hospital chair Reactive non-powered foam Reactive non-powered gel Reactive non-powered air Reactive non-powered combination Active powered alternating air cushion Equipment ordered Other The person refused equipment Not applicable or bed-bound The survey team should inspect the seat type used by the person while conducting the skin inspection on the day of the survey and choose the seating type identified in the above list that is closest to that being used by the person.. <The organisation should provide additional local information on the seating types used
pressure injury being provided to the person or their carer? 22985 Single Choice Q12. Is a pressure injury or injuries documented within the last week? Yes No Check the care plan, the eMR, progress notes or clinical notes for this information. 21168 Single Choice Q13. Is there documentation of the person being incontinent? Urinary incontinence Faecal incontinence Both faecal and urinary incontinence Catheterised with leakage Catheterised without leakage The patient is continent If Catheterised without leakage, jump to question no: 15; if The patient is continent, jump to question no: 15 Check the care plan, the eMR, progress notes or clinical notes for this information. 22698 Single Choice Q14. Is there documentation the person has Incontinence Associated Dermatitis (IAD)? Yes No Check the care plan, the eMR, progress notes or clinical notes for this information. 11996 Single Choice Q15. Was a comprehensive skin inspection conducted by the survey team, on Yes No If No, jump to question no: 22 The survey team must gain verbal consent from the person or their family or carer prior to attending the skin inspection.
Questionnaire CEC_08_PI_Prevalence_Community_Outpatient_2018_(4517) Patient Oriented Yes Questionnaire Instruction A guide for delivering the survey is available on the CEC website Creator Group New South Wales ( Pressure Injury ) Question ID # Question type Question Responses Instructions 10375 Single Choice Q1. What sex is the person? Female Male Other Record the patient’s sex from the medical record. Other should be selected when it is documented in the medical record that the patient identifies as intersex. 21167 Number with one decimal point Q2. What is the age of the person? __Years If the person is less than 1 year old please provide their age using a decimal value. i.e. 6 months is 0.5 Years 22976 Compliance Q3. Is there documentation of a fully completed comprehensive risk assessment (using a validated tool and comprehensive skin assessment) at first presentation to the community or outpatient service? Yes No If Yes, jump to question no: 5; Select Yes when there is documentation that a validated pressure injury risk assessment tool/ process appropriate for the patient population in accordance with best practice guidelines, AND a skin assessment that is based on visual inspection has occurred. Check the eMR, progress notes, clinical notes or other nursing discharge summary’s for this information. The time of admission should be available from the eMR, admission summary sheet or similar.
Assign surveyors to departments, clinical units or services Pressure injury prevention Staff xx/xxx/xxxx (1 week before survey) Pre survey email to members of survey teams Clinical Governance Unit xx/xxx/xxxx Survey date/s Carry out survey Clinical Governance Unit Pressure injury prevention Staff xx/xxx/xxxx (3 weeks after survey) District wide / facility wide post survey email with summary report Clinical Governance Unit xx/xxx/xxxx (6 weeks after survey) Provide final report to stakeholders highlighting areas of high performance and recommendations of areas for improvement Clinical Governance Unit Pressure injury prevention Staff