Cumbria Crack

Nursing teams succeed in drastically reducing pressure ulcer harm

[T]he amount of pressure ulcers (also known as bed sores) acquired by patients in north Cumbria’s hospitals and in care homes across the county, has drastically reduced thanks to the efforts of NHS staff.

Cumbria Partnership NHS Foundation Trust (CPFT) has been working in collaboration with County Council run care homes in Cumbria to reduce the amount of pressure ulcers acquired by residents. Two years on from the start of the collaboration, the care homes involved with the collaborative have not had a new pressure ulcer occurring in their care for over 500 days. are now over 500 days pressure ulcer free. The number of pressure ulcers for one district nursing team has also reduced by 70% – far exceeding the Trust’s 50% target – reducing the suffering of many patients as well as providing a cost saving of around £86,000 but most importantly preventing the avoidable harm and the pain and discomfort this results in for patients.

The collaborative with care homes has seen district nursing teams delivering training to 400 care home staff, working with patients in homes to identify warning signs, and creating prompt cards to ensure that patients are checked and turned at every opportunity to prevent pressure damage. Work is ongoing to roll the principles to other teams and care homes across north Cumbria.

At North Cumbria University Hospitals NHS Trust (NCUH) – the Cumberland infirmary in Carlisle (CIC) and West Cumberland Hospital in Whitehaven (WCH) – pressure ulcers have reduced by 61% over two years, exceeding the Trust’s target of 50%.  From April 2015 – April 2016, there were around 40-50 low-grade pressure ulcers recorded each month. This has now been reduced to around 10 per month. During 2015/2016, grade 3 and 4 pressure ulcers (the most severe) peaked at around 15 a month. In the last year this has been reduced to less than five, with some months seeing no grade 3 or 4 ulcers.

A number of the interventions were “tried and tested” during a Rapid Process Improvement Workshop (RPIW) at NCUH, carried out on one of care of the elderly wards in Whitehaven in 2017, and the successful interventions for the Trust have included:

Clocks behind patient beds –which prompt staff to know when the patient needs to be repositioned again.
Expanding the pressure ulcer prevention mandatory training to healthcare assistants and allied health practitioners as well as nurses, as their role involves “hands on care” with patients.
Encouraging staff to check patients’ skin on admission, on ward transfer and on discharge and complete a ‘body map’ which allows them to flag any issues
Bronze, silver and gold awards for staff in wards for pressure ulcer reduction.
Introducing a laminated copy of a patient leaflet for the end of bed files, recognising the importance of patient/carer engagement.
Promoting the #endpjparalysis work which encourages patients to get up, get dressed and get moving.
Recent individual ward achievements include –

  • Coronary care Unit at WCH has achieved 500 days pressure ulcer free
  • Ward 3 at WCH has achieved 200 days pressure ulcer free
  • Maple C, Beech A and Willow C at CIC has achieved 100 days pressure ulcer days
  • Larch A/B at the CIC has achieved 365 days pressure ulcer free

The two Trusts have now started to take a joint approach to tackling pressure ulcers. The tissue viability nursing teams, who work specifically to prevent pressure ulcers and improve wound healing, now meet every other month to build relationships and improve system wide patient pathways.

Fiona Kelly, tissue viability nurse at NCUH, said: “Pressure ulcers are very damaging, can be very painful and are particularly prevalent in elderly people. The prevention improvements have been fantastic, just a few years ago pressure damage was being picked up at grade 3 or 4, rather than from earlier stages.  It is rare that we see this now thanks to better skin checks from early on, which has been a concerted effort from all the nursing teams.”

Salli Pilcher, associate director of nursing at CPFT, said: “The pressure ulcer collaboration with care homes has been hugely successful and I’m very proud of the in-roads we’ve made into tackling pressure ulcers in the community. This work continues to be rolled out across all community nursing teams and embedded into their practice. Preventing pressure ulcers is the responsibility of all healthcare staff and going forward, this is a top priority for both trusts and we’ll continue to work to encourage nursing staff to to embed these good practice principles into every aspect of their job.”

Elizabeth Klein, head of nursing for clinical standards at NCUH, said: “We have struggled for many years to reduce pressure ulcer figures but seem to have had a sea change with attitude around prevention. We wanted to get the message out that it wasn’t just up to the tissue viability nurses, staff have to “own” improvements in their wards and areas.  It has been a gradual process for the Trusts to achieve these results, and one I am immensely proud of. I’d like to extend my thanks to all wards and teams, and particularly the tissue viability nurses, for making these happen and putting patient safety at the forefront of their work.

“Our joint focus now with staff in both Trusts is on sustaining the improvements and seeking assurance that the interventions are embedded at ward or community level.  We will continue to pave way for further improvements and build on the hard work that’s already been established.”

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