Eliminating Heel Pressure Ulcers
News and presentations from today’s conference chaired by Tina Chambers, Vice Chair of the Tissue Viability Society.
Jennie Hall Senior Nursing Adviser Nursing Directorate NHS Improvement Visiting Professor Kings College University and Professor Mark Radford Director of Nursing NHS Improvement open the conference with an update on 'Stop the Pressure'.
In her presentation Jennie stated:
" A good thing about the safety thermometer data, is that it's a data set taken over a long period of time"
"We are seeing a plateau in results so time is now right to refocus energy and drive improvement"
"Important to say that the National Stop the Pressure program is not the only work in the system"
"Way we are reporting and measuring pressure ulcers not consistent across the system. I'm determined to address it"
"We launched a new pressure ulcer campaign in November 2016"
"Pressure damage improvement programme, it's going to be a busy year"
"It is really important you look at what is going on in your local area"
Pre event abstract:
One of the key remaining patient safety challenges across the NHS is the rate of pressure damage for individual patients across all healthcare settings. Whilst progress has been made and this must be applauded it is clear that collectively we have reached a plateau in terms of improvement and there is a requirement to now refocus energy to further improve performance. For this reason NHS Improvement is coordinating a “Stop the Pressure” improvement programme in pressure damage in the coming months.
In the NHS in England from April 2015 to the end of March 2016, 24,674 patients were reported to have developed a new pressure ulcer (HSCIC), this means that each month between 1,700 - 2,000 newly acquired pressure ulcers are developed in 72 hours or more, after a patient is admitted to our organisations (HSCIC). Patients with pressure ulcers can stay on average 25 days in hospital (Raleigh 2009), The costs of treating a pressure ulcer varies from £1,214 to £14,108 with costs increasing with severity.
The “Stop the Pressure” Programme has been running since 2012. It commenced in NHSE Midlands and the East Region and was led by Ruth May as SRO. There were demonstrable benefits from the programme within the Midlands and East, in particular 50% pressure damage reduction which was a significant achievement.
NHSI are now relaunching the “Stop the Pressure” programme as part of a wider patient safety campaign building on the tools, knowledge and skills of the Midlands and the East Region campaign. The national programme is a system programme working across acute and community settings and in collaboration with key partners in social services and care home settings. It will link with other pressure damage programmes such as the Wound care Programme being led by NHS England which incorporates “React to Red”. The programme is focussing on improving pressure ulcer outcomes through promoting best practice, and use of measurement and improvement tools. It will directly link with Organisations to support them to make improvements, there will be a collaborative to support individual Trusts. Social media will also be used with Twitter accounts # stopthepressure to support the engagement of front line staff.
Within the next 6 months the programme will be focusing on the development and design of national architecture to support implementation of single data capture and reporting systems in 17/18 to support an ambitious level of improvement in the incidence of avoidable grade 3 and 4 pressure ulcers in 2017/18.
Jennie Hall's Biography
Jennie is Registered Nurse who trained and has worked in London. Specialising in post anaesthetic and intensive care nursing, she has been a nurse and operational leader working in Senior roles across a number of Organisations. She has a MSC in Nursing Studies, was a Burdett Scholar with the Florence Nightingale Foundation and a participant on the NHS Top Leaders Programme. She is currently a visiting professor at the Florence Nightingale School at Kings College University.
Professor Mark Radford's Biography
Mark Radford is Director of Nursing (Improvement) for NHS improvement with a portfolio that covers workforce and quality improvement.
Mark has previously been a Chief Nurse of a University Teaching Hospital and Consultant Nurse in Emergency & Trauma care. Mark is Professor of Nursing at Birmingham City and Coventry Universities.
In his presentation Mark stated: "It always astounded by the initiative and drive within the TVS community for improvement"
The morning continues with an update from Judy Elliott Tissue Viability Nurse Specialist East Kent Hospitals University NHS Foundation Trust on 'Think Heels: Communicating heel pressure ulcer prevention'.
In her presentation Judy stated:
"We launched our 'Think Heels' campaign as if we addressed heel Ulcers we could reduce deep Ulcers"
"There was a difference with the 'Think Heels' campaign as everyone was involved"
"Help teams to develop their own action plans"
"We certainly need to facilitate leaders in our staff and encourage innovation"
"Going forward develop link nurse network but want to take out the word 'nurse' and make it multidisciplinary"
Pre event abstract:
East Kent Hospitals University NHS Foundation Trust covers 3 acute sites and over 850 beds. In response to avoidable deep pressure ulcers concerns, a Task and Finish Group was formed. Data analysis showed a propensity for heel ulcers so a Trust wide ‘Think Heel’ campaign was launched in May 2014 with resource packs, exhibitions and trolley dashes around the wards. 35 wards responded by producing individualised action plans. A 50% and 25% reduction trajectory was set for deep and heel ulcers respectively.
At end of March 2015, significant improvements demonstrated reductions in avoidable heel ulcers by 69% and the total heel ulcers by 31%. The avoidable deep ulcers (potential category 3 and 4) have reduced by 59%, surpassing our 50% stretch reduction trajectory. Also reduced are avoidable superficial (category 2) ulcers by 28% against a 25% improvement trajectory. Following the success of this campaign, a further 25% reduction trajectory in heel ulcers was set from April 2015 which demonstrated a further 76% in avoidable heel ulcers.
In keeping with The NHS White Paper: The new era of thinking and practice in change and transformation (NHS Improving Quality, 2014), the success of this project is a reflection of collaborative working and transformational leadership throughout the organisation to achieve a common purpose.
In November 2015, a similar campaign was launched aimed at reducing sacral/buttock ulcers entitled ‘Bottoms Up’. Although we are still waiting to achieve the same impact, both campaigns have been refreshed during 2016 using the ‘React to Red’ strapline. Further measures to maintain and continue our pressure ulcer prevention programme highlight the important of leadership at all levels and collaborative working. They include:-
- Senior nurse supporting the Pressure Ulcer Steering group
- Develop and strengthen tissue viability link network
- Regular input at the Trust’s Quality Improvement and Innovation Hubs with link nurses leading the agenda
- Focusing on what we do well and doing better
- Celebrating success
NHS Improving Quality: The White Paper: The New Era of thinking and practice in change and transformation, a call to action for leaders of health and care, (2014)available at www.nhsi1.nhs.uk (last accessed on 17.4.15)
Judy Elliott's Biography
Following a long and varied nursing career, in 2005 I took on the challenge of Tissue Viability Nurse in a large acute Trust. My particular interest is pressure ulcer prevention and I undertook an exploratory research project in 2007 as part of my higher degree. This provided the opportunity to understand and develop practice within the Trust with demonstrable improvements in patient safety and reductions in hospital acquired pressure ulcers. I have published this work in national conferences and the Journals ‘Nursing Older People’ and ‘Journal of Community Nursing’. My Tissue Viability team has now expanded to two further TVNs and three support workers and our link nurse network is flourishing. I am proud to be part of a developing specialty which is continuously improving care for patients.
Future conference of interest:
Pressure Ulcers Summit
Monday 26 June 2017
De Vere West One Conference Centre
3 February 2017