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Implementing Stop the Pressure on the wards

Lorraine Jones, Tissue Viability Lead Nurse, The Royal Wolverhampton NHS Trust discussed Implementing Stop the Pressure on the wards at today’s conference. In her presentation Lorraine discussed:

  • building momentum for improvement
  • engaging frontline staff in preventing pressure ulcers and spreading the message of stop the pressure
  • reviewing and learning from every instance of avoidable pressure ulcers: what needs to be done
  • implementing SSKIN in practice on the wards 
  • spreading new ways of working across the organisation: what has worked for us in Wolverhampton

Lorraine Jones’s full presentation is available for download at the end of this page.

In her presentation Lorraine stated: 

"Our whole approach to avoiding pressure ulcers has been to go into the community, into hospitals and into care homes."

 "If we're providing care we need to be providing safe care no matter how many hands there are on deck."

"We're constantly rethinking things to try to get that message across."

“We are getting less pressure ulcers coming through our per 1,000 days, but we have to get it right down."

“We did an audit at New Cross to find how many people admitted with pressure ulcers died within 6 weeks and found it was 48%.”

“Concordance is a big issue, it's a huge contributing fact towards pressure ulcers. If you've got that busy person and they don't have that time to invest in them it can be very challenging.”

“We've got a very poor social deprivation in Wolverhampton and dealing with all those demands and trying to get public health messages across can be really different.”

“Around 90% of our pressure ulcers are on Caucasian skin. It does surprise, that may be cultures, using emollients over the years, but I do think we need to look into that.”

“In our trust every single nurse or HCA has to attend pressure ulcer training every two years. We have a 92% compliance rate.”

“We do find that when there's a change of leadership because they've gone on annual leave, or a change in staff because people have retired, we find that can be a huge change.”

“I feel like our healthcare assistants are absolutely key to getting down pressure ulcers.”

“Data is shared but we have to make sure it's meaningful, I'm not sure it's necessarily meaningful to the ward staff, so it's finding new ways of presenting it so everyone knows what they need to do.”

“We've got a trust action plan because we were frustrated that we weren't getting zero pressure ulcers.”

“The big thing is managing capability so nurses understand what they are accountable for. It's about taking ownership. We have to make sure we've got the assurances for what we have or haven't provided for that patient out there.”

“If we find there are gaps out there where nurses have missed vital aspects of care we start with a verbal warning.”

“So make your paperwork very simple but meaningful.”

“Reducing pressure ulcers isn't just for Worldwide Pressure Ulcer day, it's for life.”

“I once monitored a student nurse doing a lovely job looking after an elderly lady, washing and dressing her, doing a lovely job, and I say her down and asked her 'when are you going to do her skin assessment' and she said 'I'm doing that at 10 o'clock', and I said to her, 'you've just done it, record it'. I asked her when she was going to move her and she said 'after I've done the skin assessment' and I told her again, 'you've done it, you've just done it, record it'.”

“There are a load of different ideas, you have to analyse what kind of personalities you have out there and which will be the best to implement what you're planning.”

“I find there's a misunderstand of language and we have changed our documentation to say 'change of positioning' rather than 'repositioning'.”

“I tell my staff I’d rather they understood prevention that grading of pressure ulcers.”

“Dressings, get them removed, stop guessing remove the dressings.”

“We've got to get public awareness and we're always campaigning to get it out there in the public domain and educate people about pressure ulcers.”

Lorraine Jones Abstract

Since Lorraine Jones started as a tissue viability nurse, there has been real momentum in the Midlands and East area to have zero tolerance to all avoidable pressure ulcers. The SHA launched the Ambition 1- stop the pressure campaign in 2012. The leaders within the Trust supported this campaign well. This helped to drive forward changes within the Trust to prevent pressure ulcers and recognise early signs of skin changes. Some wards became involved with the SHA away days, but as a Trust they focused on a whole systems approach across the health economy. They found high level scrutiny of serious incidents highlighted senior nurse awareness of accountability and how to ensure lessons must be learnt and shared. Data has shown the Trust have reduced the number of pressure ulcers in the early stages of the campaign, but it is an on-going challenge, along with the continual increasing complexities the services are having to deal with on a day to day basis. However when the data is compared per 1000 bed days, incidence has reduced.

Lorraine Jones Biography

Lorraine Jones has been a tissue viability nurse at the Royal Wolverhampton NHS Trust since December 2010. Lorraine’s previous experience was with adult community services as a district nurse since 1995 from staff nurse to manager in varying forms across the years and also worked an additional job on the out of hours service whilst Lorraine was a lymphoedema specialist nurse at Compton hospice from 2002-2007.

Future events of interest:

Nurse Prescribing for Wound Care
Tuesday 19 January 2016
ICO Conference Centre, London

Eliminating Heel Pressure Ulcers
Wednesday 10 February 2016
Hallam Conference Centre, London

Download: Lorraine Jones"s full presentation

2 December 2015


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