PREVENTION OF PRESSURE

ULCER

• Pressure ulcers are a serious issue for patients

in all kinds of settings, even at home

• The good news is that most pressure ulcers

can be prevented

• Whats needed is an awareness on the part of

patients and health care professionals about

how pressure ulcers can be prevented

• A pressure ulcer is described as a change or

break in the skin caused by constant pressure,

especially over a bony area such as the ankle,

tail bone or elbow

• Pressure ulcers are also sometimes referred to

as pressure sores, bed sores, or decubitus

ulcers

• Pressure ulcers develop through constant pressure on a body part that causes the skin to be compressed against another surface

• Skin can also be aggravated when the body is rubbed, dragged or slid against a surface such as a bed sheet

• Most pressure ulcers can be prevented by following simple steps based on the best practice

STEP ONE

Identify those who is at risk

• Those who are unable to move due to weakness or paralysis

• Those with impaired cognitive or sensory capabilities i.e dementia, paraplegic, quadriplegic and patients with neuropathy

• Those with impaired communication abilities i.e stroke victims

• Anyone who spends long periods of time

sitting or lying down i.e those confined to

beds or wheel chairs

• Those with inadequate nutritional intake

• Those with urinary and faecal incontinence

• Those undergoing surgery i.e lying on the

theatre table for a long period of time

• STEP TWO

Put best practice activities into place

• Educate patients, caregivers and families about

their abilities to recognize ischemic pain as a

response to pressure

• Take the pressure off

• Ensure the skin is in good shape

• Ensure that the patient is adequately nourished

STEP THREE

Communicate

• To reduce the rates of pressure ulcers it is important to communicate regularly with other members of the care team

• Reduced rate of pressure ulcers can only occur with a full on culture change in the facility, not through isolated activities

• It cannot work effectively if everyone does get involved and support the process

• STEP FOUR

Continue to learn about pressure ulcer

prevention

• Continuous education

• Continuous research and development

• Continuous quality improvement

• In the quest for the prevention of pressure

ulcer, several risk assessment tools have been

produced i.e Norton scale, Branden scale and

waterlow

• There is no clear evidence that one is better

than the other

• As part of the prevention of pressure ulcers in ward 5 Queen Margaret Hospital the staff are implementing the Pressure Ulcer Incident Calendar ( The Cross )

• It is simple

• It is completed daily following assessment of all patients in the ward

• The green shade indicates no new pressure ulcer found

• The pink shade indicates new pressure ulcer found

• The yellow shade indicates patient transferred in with pressure ulcer

• The system provides the staff with a snap shot of the number of pressure ulcer incident in the ward

IMPLEMENTATION PROCESS

• The tissue viability nurse was invited to speak

to the staff

• It was highlighted to the staff the benefits of

the system to patients, staff and organisation

• It becomes part of the ward daily safety

briefing

BENEFITS TO PATIENTS

• Trust in the organisation

• Safe care

BENEFITS STAFF

• Cultural change ( a caring environment )

• Ownership ( we own it. We are proud of it )

• Group cohesion ( together we care )

• Job satisfaction ( We are very happy with our work )

• Motivation ( We will keep going on )

BENEFITS TO THE ORGANISATION

• Reduction in cost – materials and manpower

• Reduction in the length of stay – freeing more beds

THANK YOU FOR LISTENING

Leading Better Care

24th March

Falls - Integration with Clinical Quality Indicators (CQI’s)

Why focus on falls?

“There are few other examples of such a common serious presentation, with such compelling evidence of effective treatment that has been so neglected by healthcare professionals” McMurdo 2002

Poor transfer and translation

• ‘despite evidence and mandates, falls remain largely ignored with poor transfer of research evidence’ (Baker et al 2005)

• Fall and fracture prevention has been a low priority in service delivery, training and research (Oliver 2007)

• “Effective strategies to prevent falls have been identified but are underutilized” (Tinnetti 2008)

National Patient Safety Agency (NPSA)

A patient falling is the most common safety incident reported from inpatient services

Interplay of risk factors in hospital

• Acute condition precipitating admission • Pre-existing illness/conditions• Physical and functional impairments• Multiple medication use• Disorientation in unfamiliar surroundings• Environmental hazards

Rehabilitation

• Regaining independence involves risk• Patients relatives understand the

hospital to be a place of safety• Conflicting expectations• Involvement is key – written and

verbal information

The Clinical Quality statement for falls

“Nursing Staff will work with patients and their carers to strike the right balance between preventing falls and promoting independence, privacy, dignity and rehabilitation”CDC, 2005; USDHHS, 2004

Exclusions: Patients under 65 years with no history of falls. Patient admitted less than 24 hours. Patient has not fallen.

NHS Highland introducednew documentation-CQI

Morse score – predictive falls risk tool– validated in the in-patient setting

– chosen by NHSH high specificity and sensitivity

• Core Care plan for falls • Patient Information leaflet

Falls risk scores

Reviews show risk scores

• identify half of hospital patients as high risk

• higher proportions of ‘high risk’ in high risk specialities

Prediction NOT prevention

• Falls risk scores predict falls• Do NOT prevent falls

Identify and address

MODIFIABLE RISK FACTORS

Well established evidence base for interventions that prevent falls

• clinical • environmental

1. NHS Ayrshire & Arran

109 people/km2

2. NHS Borders

24 people/km2

3. NHS Dumfries & Galloway

23 people/km2

4. NHS Fife

272 people/km2

10. NHS Lothian

460 people/km2

9. NHS Lanarkshire

257 people/km2

8. NHS Highland

9 people/km2

7. NHS Greater Glasgow & Clyde

1,036 people/km2

6. NHS Grampian

61 people/km2

5. NHS Forth Valley

110 people/km2

14. NHS western isles

9 people/km2

13. NHS Tayside

52 people/km2

11. NHS Shetland

15 people/km2

12. NHS Orkney

20 people/km2

Leading Better Care Facilitators

Intuitive training pack

• based on adult learning theory

• doesn’t give the answers

• followed up by power point of the evidence at the end of the training

Simple training pack

• Participants work in pairs• Both contribute• Profile with typical presentation• Include modifiable risk factor/s to be

identified by each pair

Download from NHSH Intranet

Go to

• Projects• Leading Better Care

• Clinical Quality Indicator (left side)

• Bottom of page

• Resources• Click to download

Clinical Quality Indicators (CQIs)

Process indicators Focus on quality improvement Measure aspects of nursing care • assessment • interventions

CQI’s – top tips

• Measuring the measurable• Protecting our staff• Improve quality

References

1 NHS Quality Improvement Scotland (2005) Working with Dependent Older People

towards Promoting Movement and Physical Activity.

2 National Patient Safety Agency (2007) Slips, trips and falls in hospital.

3 The Joanna Briggs Institute for Evidence Based Nursing (1998) Falls in

Hospital. Evidence Based Practice Information Sheets for Health Professionals, Vol

2, Issue 2.

4 Royal College of Nursing (2004) Clinical practice guideline for the assessment and

prevention of falls in older people.

5 National Institute for Clinical Excellence (2005) Falls. The assessment and prevention

of falls in older people. Clinical Guideline 21

WELCOME

Susan Skinner

SCN

Nairn Town & County

Hospital

NHS Highland

Linda Burgin

Nutrition Champion

NHS Highland

March 2010

INTEGRATION withClinical Quality Indicators

Core Nutritional Pathway

What we hope to achieve

with Food Fluid and Nutrition

CQI’s?

Where’s the patient?

What is role of SCN/M in Nutrition?

• Effective leadership

• Communication

• Prioritising and making time for

education

• Reviewing practices

• Ensuring resources are fit for

purpose

Nutrition Champions Role

• Leadership

• Communication

• Education of

SCN and

feedback

• Visible,

accessible and

approachable

Celebrating the SCN/M Role

• Motivation of team

• Action learning

• Sharing

information

• Enthusiasm

• Recognising role

• Giving ownership

and responsibility

to the team

Linda Celebrating Susan's Role

• Team work

• Seeing, sharing and celebrating results

• Embedding CQI’s into everyday clinical

practice

• Encouraging and enabling Susan

Quotes

“A team approach which includes nursing, catering and dietetics has significantly contributed to equitable overall nutritional care of the patients”Mairi Wotherspoon, Dietitian, Nairn Town & County Hospital

“Leadership and ownership from all levels which breeds enthusiasm for nutrition, has seen a happy, healthy working ward where nutrition is on everyone's agenda”Mairi Wotherspoon, Dietitian, Nairn Town & County Hospital

Quotes

“Seeing nutrition firmly embedded in the team approach and ward routine makes the job worthwhile”

Linda Burgin, Nutrition Champion, NHS Highland

“Adequate nutrition is a basic human right and evidencing the quality of Food Fluid and Nutrition using CQI’s is the cornerstone that highlights good nursing care.”

Hilda Hope, Lead Nurse SE CHP, NHS Highland

Susan's 3 Top Tips

• Be part of Releasing Time to Care to make time for Leading Better Care

• Be prepared to take ownership of the project to create success

• Take your staff with you so they view it as their project and not just yours

Linda’s 3 Top Tips• Be enthusiastic and use your

past experience to encourage

and enable others

• Remember its all about

improving your patient’s

experience

• Be visible, accessible and

approachable

Goodbye and Thank You

Any Questions?