Preamble
BigDog Support Services Pty Ltd (BigDog) ensures that each client requiring complex wound management receives appropriate support relevant and proportionate to their individual.
BigDog considers it imperative to involve our clients in all aspects of their service delivery and the direction of their services to their ability. The dignity of risk is an essential part of this choice and control.
Details
Wound healing is a complex dynamic biomechanical process as the body attempts to restore the integrity of traumatized or devitalized tissues. Complex wounds are defined as longstanding tissue injuries that cannot be treated with conventional methods of wound dressing or closure either due to local tissue factors or systemic factors.
For a wound to be classified as a complex wound, it should show one of the following features:
1. Persistent for more than three months.
2. Compromised vascularity or necrosis.
3. Presence of infection.
4. Associated comorbidities impair healing potential.
There are many factors, both local and systemic, that can affect wound healing. Local factors include wound depth, infection, peripheral vascular disease, radiotherapy, sustained pressure, and excessive moisture. While systemic factors include metabolic disorders such as diabetes mellitus, immunodeficiency, and nutritional deficiencies.
Pressure Sores
Pressure injury is an injury to the skin resulting from pressure, shear and/or friction. Pressure causes a loss of oxygen and nutrients to the area leading to tissue damage and skin breakdown. A shear or friction injury can occur by rubbing or dragging, for example sliding down the bed or putting on clothing.
Pressure injury can affect any part of the body. Common sites are bony prominences such as the heels, elbows, spine and back of the head.
Plan Development
Each client is involved in the assessment and development of the plan for their complex wound management. With their consent, each participant’s health status is subject to regular and timely review by an appropriately qualified health practitioner. At a minimum the plan must include:
Information on the type of wound.
Wound care required.
Frequency of wound dressing and change.
How to identify symptoms that require action and the action required.
Guidelines for how to provide complex wound care.
Specific individualised requirements.
Policies and Procedures
BigDog has appropriate policies and procedures in place, including a training plan for workers, that relate to the support provided to clients requiring complex wound management.
Support Worker Training
BigDog will ensure that each worker has completed training, relating specifically to the client’s needs that are affected by their wound management regime (for example, showering, toileting and mobility) and high intensity support skills descriptor for providing complex wound management, delivered by an appropriately qualified health practitioner or person that meets the high intensity support skills descriptor for complex wound management.
Wound Care and Pressure Injury Management Part 1
In part 1 of this NGO course, workers will learn what wound care and pressure injury management is, and the important role of disability support professionals in providing support. They will learn about the different types of wounds, how they are caused, and recommended equipment to treat and support healing. Workers will identify risk factors and symptoms associated with complex wounds and pressure injuries. Lastly, workers will learn about prevention strategies that can be used to reduce the occurrence of pressure injuries and promote the wellbeing of clients with complex wounds and pressure injuries.
After this lesson workers will be able to:
1. Understand what wound care and pressure injury management is, identify different types of wounds and the equipment required to treat them.
2. Identify risk factors, recognise symptoms of pressure injury, and know how to apply prevention strategies.
Course duration: 30 minutes
Wound Care and Pressure Injury Management Part 2
In part 2 of this NGO course, workers will learn more about their role and responsibilities providing support for clients with complex wounds. Workers will learn about Wound Care Plans and documentation requirements associated with wound care procedures. Workers will understand the skills, knowledge, and competencies you must demonstrate to perform high risk wound care procedures. Lastly, they will learn about common complications, risks, and their role in identifying, reporting, and taking action to minimise risk and manage complications associated with complex wounds and pressure injuries.
After this lesson workers will be able to:
1. Understand their role as a support worker in monitoring clients who require wound care support.
2. Identify common complications and how to respond to incidents and emergencies.
Course duration: 35 minutes
Any other client specific training will be delivered by an appropriately qualified RTO.
Procedure
Pressure sores can occur rapidly and quickly progress deep into the muscle, leading to pain and infection of the local area, bloodstream, bones and joints. Preventative measures should be discussed with the client, their family and the appropriate health professional. Always refer to the person’s Health Care or Wound Management Plan.
Daily Skin Care
Clients thought to be at risk of developing pressure injuries should have a skin check at least twice a day. This can be incorporated into their daily personal care routine. Any redness, discolouration or bruising should be documented on CareMaster.
Use a gentle soap or soap substitute to prevent the skin from becoming dry. Ensure the skin is dried thoroughly after washing. Check skin folds and creases for redness and breakdown. Apply a moisturising product to any dry skin. Topical agents such as fungal creams may be ordered and should be applied as prescribed.
If the client wears a continence pad, ensure this is changed at frequent intervals and the skin washed and dried thoroughly. Barrier creams can be used as prescribed, but these should not be relied upon. Good continence management is most effective.
Skin over bony areas such as elbows, sacrum and heels are often delicate. Apply cream gently and avoid massaging the area.
Change of Position
The client should be encouraged and supported to change position at least every 2 hours. This relieves pressure and restores blood supply to the area
Always ensure correct lifting techniques are used when supporting a client to change position. A slide sheet or hoist may be appropriate. All workers should receive training in the use of equipment by an appropriate health professional.
Ensure the person is not sitting or lying on creased clothing or sheets. Buttons, zippers or clothing with thick seams will also increase pressure to areas of the skin.
Encourage the client to maintain a good posture when sitting in a chair by sitting well back in the chair and maintaining an upright posture. Check elbows are not at risk of increased pressure when resting on the arm rest.
Pillows and cushions can be used to protect bony prominences.
Pressure area care should be taken into consideration for all equipment prescribed for the client. This includes wheelchair, bed, shower/commode chair and sling. All equipment should be checked prior to use. Many wheelchairs have an option to tilt the seat to change position or a pressure relieving cushion can be used. The cushion should be selected in consultation with an Occupational Therapist or Physiotherapist as not all cushions are suitable as some may increase pressure.
A pressure relieving mattress can be used in bed. This should be ordered by an Occupational Therapist to ensure it is appropriate for the person we support.
Diet and Lifestyle
A healthy and nutritious diet should always be encouraged, but especially in those at risk of pressure injury. Weight loss and malnutrition have been linked to the development of pressure sores.
Summary
Any client who requires complex wound management receives appropriate support relevant and proportionate to their individual needs.
Consistent, accurate, and thorough wound care documentation is vital for providing highquality wound care support, ensuring client safety, and supporting effective collaboration with the health practitioners and professionals in the client’s support network.
How to document wound care
Use a standardised wound care chart form that includes fields for essential information related to the wound, such as wound characteristics, size, and treatment required, and provided.
Document the date and time of each wound care intervention. This ensures a chronological record of the care and support provided.
Describe the wound's location, size (length, width, depth), and appearance. Include details on wound \edges, surrounding skin condition, and any signs of infection, such as redness, warmth, swelling, or drainage.
Document the type of wound cleaning solution used, the method of wound cleaning, and any response from the client during the procedure. List the specific wound dressing applied, including the brand, size, and any additional materials used.
Note any changes in the wound's appearance, size, or characteristics since the previous wound care provided and wound dressing change. Record any signs of improvement or deterioration in the wound's condition.
Include the client’s self-reported pain level, if applicable, before and after wound care interventions. Use a pain scale to quantify pain intensity.
Assess and document the integrity of the skin and tissues surrounding the wound, noting any changes or abnormalities.
Document the use of any specialised wound care equipment and devices (such as negative pressure wound therapy) including application and specific settings.
Include any communication with healthcare professionals regarding the wound's progress, concerns, or changes in the wound care plan and progress or shift notes.
Document the client’s response to the wound care procedure, any pain or discomfort reported during the wound dressing change, and their understanding of wound care instructions, if applicable.
Note any safety precautions taken during wound care and adherence to infection control protocols.
Sign to validate your documentation.
Continuously update the wound care documentation with each intervention or significant change in the wound's status.
Any high intensity daily personal activity and management forms part of the formal training program and must be signed off by a Registered Training Organisation (RTO).
Forms
Client Profile Kit
NGO Course Report
NGO User Report
Training Attendance Sheet
Information Sheets
Equipment for Wound & Pressure Injury Management
How to Document Wound Care
Pressure Injuries
Sepsis Factsheet
Skin Assessment Procedure
NGO Training
Pressure Sores
Wound Care and Pressure Injury Management Part 1
Wound Care and Pressure Injury Management Part 2
Legislation
Disability Discrimination Act 1992 (Cwth)
Disability Services and Inclusion Act 2023 (Cwth)
Disability Services Act 2006 (QLD)
Health Act 1937 (QLD)
Health Regulation Act 1996 (QLD)
National Disability Insurance Scheme Act 2013
NDIS (Provider Registration and Practice Standards) Amendment Rules 2021
Queensland Guardianship and Administration Act 2000 (QLD)
Queensland Human Rights Act 2019 (QLD)
Queensland Mental Health Act 2016 (QLD)
NDIS Practice Standards and Quality Indicators
BigDog Support Services Pty Ltd (BigDog) is a registered NDIS provider and is required to apply the scheme’s practice standard and quality indicators.
The standards have been developed to create an important benchmark to assess provider performance and ensure that high quality and safe supports and services are provided to NDIS clients.
The four core modules are:
1.0 Rights and Responsibilities;
2.0 Governance and Operational Management;
3.0 The Provision of Supports; and
4.0 The Support Provision Environment.
The supplementary modules cover:
5.0 Specialist Support
5.1 High intensity daily personal activities
5.2 Implementing behaviour support plans.
5.1 High Intensity Daily Personal Activities
These NDIS Practice Standards set out the responsibilities of BigDog when providing supports and services to clients that require the following.
5.1.1 Complex Bowel Care
5.1.2 PEG Feeding and Management
5.1.3 Severe Dysphagia Management
5.1.4 Tracheostomy Management
5.1.5 Urinary Catheter Management
5.1.6 Ventilator Management
5.1.7 Subcutaneous Injections
5.1.8 Complex Wound Management
5.1.8 Complex Wound Management
Each client requiring complex wound care receives appropriate support relevant and proportionate to their individual needs
Human Services Quality Standards
The Standards set a benchmark for the quality of service provision. Each Standard is supported by a set of performance indicators which outline what BigDog is required to demonstrate to meet that standard.
3 Responding to Individual Need
The assessed needs of the individual are being appropriately addressed and responded to within resource capacity.
3.3 BigDog ensures that services to the individual/s are delivered, monitored, reviewed and reassessed in a timely manner.
6 Human Resources
Effective human resource management systems, including recruitment, induction and supervisory processes, result in quality service provision.
6.3 BigDog provides people working in BigDog with induction, training and development opportunities relevant to their roles.
Delegation of Authority
Name Position Details
Steven Paull Director
Courtney Carroll Director
David Burrett Operations Manager
Monique Paull HR Manager Lawyer
Authorise review and implementation
Authorise review and implementation
Ensure information dissemination
Ensure compliance by employees
Version Details
This policy will be reviewed every twelve (12) months unless circumstances deem it necessary to review earlier. The review process will involve an analysis of the usefulness of the policy and to note any changes which are required to improve the policy. If minor changes are made in wording or to clarify the intent, the version number will indicate this by adding a ‘point’ i.e. Version 1.0 indicates the original version and 1.1 with the first round of minor changes made. A significant change or intent of the policy will be indicated by a whole new number i.e. Version 2.0.
The following rules also apply in interpreting this policy:
• Headings are for convenience only and do not affect interpretation.
• A singular word includes the plural and vice versa.
• A word that suggests one gender includes the other genders.
January 2023
March 2024
5.1 Updated Responsible Offices details and NDIS (Provider Registration and Practice Standards) Amendment Rules 2021
6 0 Included Human Services Quality Framework (HSQF) and Child Protection Act and the term “Client” is returned to “Client” to allow for policies to cover NDIS and HSQF.
6.1 Disability Services Act 1986 replaced with Disability Services and Inclusion Act 2023 and policy review process included