Pressure Sores Performance

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Pressure ulcers (or bed sores as they are more commonly known) occur when the skin and the tissue beneath it becomes damaged. In very serious cases, the muscle and bone can also be damaged.

Pressure ulcers are caused by pressure as the weight of the body presses down on the skin; when layers of the skin are forced to slide over one another, for example, when you slide down a bed or in a chair; or through friction. Rubbing the skin can increase the risk of pressure ulcers developing.

Pressure ulcers are a widespread and often underestimated health problem. In the UK, it is estimated that between 4% and 10% of all patients admitted to hospital will develop at least one pressure ulcer. For elderly people with mobility problems, the figure can be as high as 70%.

Most pressure ulcers that develop in the NHS are preventable and preventing them happening improves the care for vulnerable patients as they cause long-term pain and distress and can also mean a longer stay in hospital. Making regular and frequent changes to a patient's position is one of the most effective ways of preventing pressure ulcers. Regular inspection of high-risk pressure areas is also important to detect early signs of any ulcers.

Key Improvements

During the last 12 months, we have continued to work hard to prevent patients from acquiring avoidable pressure ulcers in our care. We have developed smarter systems to provide frontline staff with the support and advice they need to care for our vulnerable patients.

Our doctors and nursing staff are being encouraged and empowered to make pressure ulcer prevention a key priority as part of the Trust's patient safety agenda, resulting in real change in attitude in this area.

The ways in which pressure ulcers are reported and the standards of reporting vary hugely from Trust to Trust. However, at this Trust, we have made significant progress in the last year to ensure we have a common approach to dealing with pressure ulcers, particularly with our record keeping and risk assessments. Through greater awareness and improved training, our staff are now better at identifying, reporting and managing pressure ulcers.

Reduction in the number of pressure ulcer incidents

Pressure ulcers are classified according to their estimated tissue depth. The Trust is required to report all stage 2 and above pressure ulcers as a clinical incident. A significant reduction in the number of incidents has been reported over the past year. More detail on these figures can be found in the Trust's Quality Accounts Reports.

Improving skin assessment skills

It was acknowledged that practitioners need greater guidance and education around assessing skin and understanding how to differentiate pressure ulcers from other skin lesions. Ongoing training is provided at the bedside resulting in more effective prevention and treatment outcomes for the patient.

Pressure ulcer validation

In response to the need for accurate pressure ulcer data reporting, our Tissue Viability Specialist Nurses have adopted new ways of working. They receive an electronic notification as soon as a new hospital acquired pressure ulcer is identified and reported. This allows them to validate or verify the tissue damage (providing confirmation of the cause and severity of the skin damage) working alongside frontline staff. For the patient, this means the right treatment can be provided in a timely manner and for the Trust, it means we have much greater confidence in the accuracy of our pressure ulcer figures.

Removing the pressure

We recognise that the heel is an area of the body at greater risk of developing pressure ulcers. Moving forward, we have equipped our wards with additional heel off loading aids. In total, 320 aids have been purchased this year, equating to an investment of £13,000. This equipment allows the patient's heel to be free of any pressure and is a well-recognised strategy for preventing pressure ulcers.

Clinical assessment tool

We have introduced a new pressure ulcer clinical reference tool, which staff use at the patient's bedside to help correctly grade pressure ulcers and to describe the severity or potential depth of tissue damage. It provides greater accuracy to pressure ulcer reporting and documentation processes. Communicating the severity of pressure ulcers is essential for high quality care. Pocket guides have been developed for relevant frontline staff, allowing for better assessment of skin damage.

SKIN bundle

The SKIN Bundle (an acronym for Surface, Keeping moving, Incontinence, Nutrition) is an assessment tool to help staff focus on key interventions to prevent pressure ulcers. It prompts staff to remember elements of good pressure area care in a reliable way. The tool was rolled out across the Trust two years ago and has now become firmly embedded into clinical practice and patient care.

Education and Awareness

The Trust continues to proactively take part and lead in staff education and local public awareness campaigns to raise the profile of pressure ulcer prevention and treatment. Last year, events included International Stop Pressure Ulcer Day in November and an education event for healthcare professionals held in April at our hospital in Fairfield. The event brought together staff from local nursing homes, hospital wards, community nursing teams, podiatry and tissue viability services. The theme was achieving harm-free care in relation to pressure ulcers. Both campaigns were run in partnership with the national Your Turn campaign.

The Trust has introduced an innovative risk assessment tool aimed at patients who are at risk of pressure damage from orthopaedic devices such as plaster of paris. This work has been shared at a national wound care conference.

We have also produced a patient information leaflet on preventing pressure ulcers. This is widely used across the Trust and is also available on our website.

Clinical engagement

The last twelve months has seen the development of new support groups, led and facilitated by our clinical matrons, specifically designed to work closely with frontline staff. These initiatives have enabled more effective dissemination of new developments and changes within the field of pressure ulcer care. They provide an opportunity for education and sharing of best practice. Group members act as Pressure Ulcer Champions, helping the Trust to drive forward excellence within skin care prevention and treatment and challenging outdated practices and cultures.  

More information can be found in our annual Quality Accounts reports.