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Eliminating Heel Pressure Ulcers: Speaker News and updates

Pressure Ulcers are a priority focus area for 2016/19 for NHS Improvement as the first part of their programme on patient safety initiatives;  “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…Collectively we should not feel that this is an acceptable position for our patients…In May 2016 4.5 % of reported ST patients had a pressure ulcer = 8,426 patients…We are seeing a plateau and variation in organisations”  NHS Improvement February 2017

Chaired by Tina Chambers, Past Chair, Tissue Viability Society, and Tissue Viability Consultant Educator and Advisor this national conference provided a practical guidance for eliminating avoidable heel pressure ulcers and improving care and treatment.

Speaker News and Presentations

Stop the Pressure: An update from NHS Improvement

Jacqui Fletcher, Senior Clinical Adviser Nursing Directorate, NHS Improvement

  • stop the pressure update

Jacqui Fletcher’s Full Presentation Click Here

In her presentation Jacqui stated: 

“In light of the campaigns for Pressure Ulcers we have noted a significant drop in the number of pressure ulcers”

“STPP is really focused on standardised practice across all services – we feel it is important to stop pressure ulcer in all services”

“Pressure ulcers is an improvement priority within the NHSI business plan for 2016/17 and 2017/18”

“We want to review the delivery of pressure ulcer prevention education and develop a national curriculum and competency framework to be used by both pre-and post qualification staff”

“This summer we will be setting up a collaborative to make small improvements. We will be bringing in 20 organisations to look at this.”

“We contacted Trusts and asked for there improvement plans we received 172 plans out of 248 Trusts.” The General themes included:

  • There is a great deal of positive activity being undertaken at Trust level across the regions. 
  • This was evident from the content of many plans,  the number of attachments that were submitted and the offer to work with the national campaign going forward.
  • There is good evidence of partnership working across health and social care settings. 
  • Some Trusts have seen significant improvement in performance over the last 2-4 years with focussed programmes.   
  • There is a commonality of overarching themes within the plans
  • Some regional variation where initiatives such as React to Red have been promoted as a way forward.  
  • The content of many of the plans indicates that there are some themes which the NHS as a system continually focusses on, there is a significant challenge to deliver sustainable change so that Trusts are not repeating actions multiple times, some Trusts appear to have achieved sustained change and we should share the learning from those Organisations.  

“There are also some topics which did not appear strongly in the review of plans, there will need to be consideration of how these topics are taken forward. Like nutrition, incontinence management, patient experience, seating, bariatric care, A&E and also the larger patient”

“National Audit – the focus is on understanding what is happening not just on counting”

Jacqui Fletcher’s Presentation Abstract:

The “Stop the Pressure” Programme (STPP) has been running since 2012.   It commenced in the Midlands and the East Region of England.  There have been demonstrable benefits from the programme, and since late 2016 STPP has been re energised and is being delivered as a national programme.

STPP is a system wide improvement programme working across acute and community settings.   It is also working in collaboration with key partners in social services and care home settings.    It is not an isolated programme in relation to pressure ulcers and supports matrix working with other programmes being led by other partners e.g. NHS England and the Academic Health Science Networks.  The programme which is integrated with NHS Improvement as part of a wider Patient Safety Campaign, was an improvement priority within the NHSI business plan for 2016/17 and 2017 / 18.

The programme aims to:

  • Develop and implement national definitions
  • Develop and implement local reporting mechanisms
  • Develop and implement and national measurement strategy
  • Deliver an improvement collaborative to tackle variation in practice in providers
  • Review delivery of pressure ulcer prevention education and develop a national curriculum and competency framework to be used by both pre-and post qualification staff
  • Develop a strategy for public engagement in pressure ulcer prevention.

Jacqui Fletcher’s Biography:

Jacqui Fletcher is currently an Independent Wound Care Consultant, Senior Nurse Advisor – Stop the Pressure Programme (NHS Improvement) and  Editor of Wounds UK journal.

 Prior to this Jacqui was the Clinical Strategy Director at the Welsh Wound Innovation Centre and had an honorary clinical contract at Cardiff and Vale UHB. Jacqui was an Honorary Fellow of the National Institute for Health and Care Excellence (NICE) from 2011 - 2014. She has worked for Midlands and East Strategic Health Authority as Harm Free Care Lead, focussing on the ambition to eliminate all avoidable category 2,3 and 4 pressure ulcers. She has also worked as a Principal Lecturer, University of Hertfordshire.

She is a Patron of the Lindsey Leg Club, and a member of the Editorial Advisory Board for International Wound Journal, the Journal of Wound Care and Wounds UK journal. She served as an Executive of the European Pressure Ulcer Advisory Panel from its inception in 1996 until 2010 and was instrumental in developing the 2009 guidelines serving as a lead for a working group.

She has published widely and speaks at both national and international conferences.

Think Heels: Communicating heel pressure ulcer prevention

Francesca King, Tissue Viability Nurse, East Kent Hospitals University NHS Foundation Trust

  • Implementing a Trust wide campaign; getting the message across
  • Transformational leadership - initiating and sustaining practice improvements
  • Producing a resource pack
  • Learning and future developments

Francesca King’s Full Presentation Click Here

In her presentation Francesca stated: 

“EKHUFT has over 1109 beds throughout 3 acute hospitals. Continuous actions to reduce deep ulcers but a 50% reduction trajectory in 2013-2014 was unmet. Data analysis showed heel ulcers (more likely to be deep) and it was rationalised that if heel ulcers were reduced, so would deep pressure ulcers.

This resulted in the set up of a special deep ulcer task force lead by the Deputy Chief Nurse and in May 2014 the ‘Think Heels’ campaign was launched.”

“We developed an action pack containing a call to Action letter - explaining purpose of the campaign and providing their number of avoidable heel ulcers, a self assessment questionnaire, a letter for the Matrons and how they can influence their teams, a letter for patients explaining the campaign and how they can become involved in self care, an action plan template, an audit template, a heel care plan, a heel protection protocol, Posters for display and Mirrors”

“We used the packs to encourage wards to plan and audit what they were doing”

“We developed a heel care plan and heel protection protocol”

“35 Wards returned their action plan. Avoidable heel ulcers reduced by 69% at end of March 2015 and deep ulcers by 59%, a further 25% reduction trajectory set from April 2015. 76% reduction in avoidable heel ulcers achieved by end of March 2016.”

Francesca King’s Presentation 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

Francesca King’s Biography:

Francesca King qualified in September 1997 and her interest in Tissue Viability grew when she was appointed the link nurse in the ward that she worked on at the time. They won a trust award for the work they did reinstating Larvae therapy back into the trust with great results. In 2000 Francesca took on the challenge of Dermatology nurse specialist as a 6 month secondment which ended up being a 13 year post. In this time Francesca gained her Bsc honors degree and independent nurse prescribing qualifications. Although this role was mainly in outpatients Francesca undertook a great deal of leg ulcer assessments and went onto complete the Wolverstan institute leg ulcer course.

In 2013 Francesca was given the opportunity of the Tissue Viability Specialist role. Within this role Francesca is able to assist the lead TVN to demonstrable improvements in patient safety and reductions in hospital acquired pressure ulcers. 

Future events of interest:

Implementing the NICE Guidance & updated Quality Standard on Diabetic Foot Problems Prevention and Management
Friday 6 October 2017 
De Vere West One Conference Centre, London

Pressure Ulcers Summit
Thursday 7 December 2017 
Manchester Conference Centre, Manchester

17 July 2017


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