RCN Patient Safety & Quality Conference Pressure Ulcer Prevention Vanessa McDonagh Tissue Viability CNS
Fact 67,848 patient safety incident reports to the NRLS relating to pressure ulcers between 1 st September 2010 and 31 st August 2011
Some more facts Pressure ulcers are estimated to affect between 4 20% of patients admitted to acute care Pressure ulcers are estimated to affect 30% of people in the community Pressure ulcers are estimated to affect 20% of people in nursing and residential homes (Clarke, Bours, Defloor 24)
In summary Pressure ulcers are common Pressure ulcers are devastating Pressure ulcers are life threatening Pressure ulcers are expensive ( 1.4-2.1 billion annually 4% of the NHS expenditure) Pressure ulcers are (mostly) avoidable!
Is this acceptable?
Avoidable?? Avoidable Pressure Ulcer: Avoidable means that the person receiving care developed a pressure ulcer and the provider of care did not do one of the following: evaluate the person's clinical condition and pressure ulcer risk factors; plan and implement interventions that are consistent with the persons needs and goals, and recognised standards of practice; monitor and evaluate the impact of the interventions; or revise the interventions as appropriate. DH 2010
Unavoidable??? Unavoidable Pressure Ulcer: Unavoidable means that the person receiving care developed a pressure ulcer even though the provider of the care had evaluated the person s clinical condition and pressure ulcer risk factors; planned and implemented interventions that are consistent with the persons needs and goals; and recognised standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate; or the individual person refused to adhere to prevention strategies in spite of education of the consequences of non-adherence DH 2010
Is there guidance?
So what s the problem?
Barriers to preventing pressure ulcers What nurses have told us Workload Dependency Poor staff motivation/ morale Inaccurate assessments Shortage of staff Lack of TVN s Poor reporting and follow up Skill mix Poor communication Poor leadership Lack of equipment Lack of knowledge
So what are you going to do?
Local Driver diagram
Things you might like to try Visualise pressure ulcer free days within the clinical area SKIN Surface keep moving incontinence nutrition A SKIN tool Intentional Rounding/ Comfort rounds
Patient identification label DATE: TIME: 06 ASK Is the call bell in reach? Do you need the toilet? Are you in pain? Do you need help? SURFACE to be completed every shift Mattress = risk score + patent Cushion = risk score + patent SKIN INTEGRITY Check skin and document changes on The Skin Assessment form KEEP MOVING Reposition 2-4 hourly as care plan(use 30 degree tilt & slide sheets) Left side Right side Back Sitting (max 2 hourly intervals) INCONTINENCE Is patient clean & dry? Ensure cleaned with a ph balanced cleanser Has the pad been changed? Catheter/Flexiseal patent & necessary? NUTRITION Is patient s drink within reach? Fluids taken/given: Ensure recorded on fluid balance chart Supplements/snacks offered/ given Nurse responsible for care: Initials Nurse in charge to check as a minimum Once in 24 hours Initials INTENTIONAL ROUNDING INCORPORATING A.S.S.K.I.N TOOL 07 08 09 10 11 12 13 14 Nurse in charge to decide how often round is to be completed hourly 2 hourly 3 hourly 4 hourly Key: ASK: Ask patient questions SURFACE: Insert the name of the mattress, cushion and bed being used KEEP MOVING: Record position and when repositioned INCONTINENCE: Ensure skin is cleaned with ph balanced cleanser NUTRITION: Ensure referred to dietician if nutritionally at risk or category ¾ pressure ulcer N: Normal RB: Red & Blanching RNB: Red Non Blanching Grade 1 PU BL/SC: Blister or scuff mark Grade 2 PU PU: Pressure ulcer state ¾ M: Moisture/excoriation damage : Yes X: No N/A: Not applicable 15 16 17 18 19 20 21 22 23 24 01 02 03 04 05
Content area Drivers Risk identification Risk assessment Interventions Understand the risk factors for acquiring PU Understand the local context & analyse local data to assess patients on ward/unit most at risk Assess PU risk on admission for ALL patients Re assess skin as a minimum daily Initiate & maintain correct and suitable preventative measures Reduce the % of hospital acquired PU Reliable implementation of the ASSKIN Tool Identification, grading of PU existing on admission/transfer & appropriate intervention Address these areas: Surface Skin Integrity Keep Moving Incontinence Nutrition Initiate and maintain correect and suitable treatment measures Utilise the local Tissue Viability nursing expertise Education Educate staff regarding the assessment process, identification and cladssification of, and treatment of PU Educate patient's family Develop patient information pack
Preparation Staff Briefing and brainstorm with all members of MDT on ward. Be aware they are not acceptable. RCA and action plans when they occur Develop SKIN Bundle into care plans and rounding add to communication tool Ensure staff are educated with TVN support Ensure PU prevention is given high priority e.g. team briefing, posters, visual cues Develop patient information leaflets ensure they are visible and pressure ulcers are discussed with carers and patients. Patient involvement is essential
Outcome measures Document pressure sores of all grades (1-4) Count days since last pressure ulcer developed on this ward and display on Safety Cross Clinical Incident form for any sore grade 2 and above RCA and action plans for grade 3 and 4 Calculate rate per 10 bed days
In the words of a great man... A little less conversation and a lot more action... Elvis Presley
Thank you
Can you imagine what you would do if you could do all you can? Tse chu