Pressure Ulcers Summit: News and Updates
This summit aimed to bring together tissue viability, wound care leads and senior nurses to discuss the important issue of eliminating avoidable pressure ulcers. The conference will cover implementing the national stop the pressure campaign and monitoring progress against the National NICE Quality Standard for Pressure Ulcers. Pressure Ulcers have recently been announced as a key priority area for the new patient safety collaboratives and pressure ulcer prevention is a key NHS Outcomes Framework Improvement Area.
The conference will open with a national updates updating delegates on developments in pressure ulcer prevention, and monitoring progress against the national quality standard released last year. The conference will continue with case studies focusing on developing a regional collaborative approach to reducing pressure ulcers, eliminating pressure ulcers on the ward, sustaining pressure ulcer prevention towards zero pressure ulcers – in hospitals and working with community and care homes: moving beyond 100 days free. Practical case studies will focus on reducing and preventing pressure ulcers, in depth extended sessions focusing on pressure ulcer grading and reporting including unstageable pressure ulcers, latest evidence on risk assessment, pain as a predictor of pressure ulcer development and factors associated with severe pressure ulcer development, pressure ulcers and safeguarding, and developing your skills in root cause analysis and investigation. The event will look at this issue of avoidability and discuss the latest evidence on what is actually considered unavoidable.
Speaker News and Presentations
Stop the Pressure: Moving Forward
Jennie Hall Senior Nursing Adviser Nursing Directorate NHS Improvement Visiting Professor Kings College University
- stop the pressure: national update
- pressure ulcers and the 6C’s: moving forward
In her presentation Jennie stated:
“I’m not a tissue viability nurse by background,” she said. “But it’s a subject I've been well aware of right throughout my career.
"Collectively we have made some really good progress nationally around pressure ulcers over the last four or five years, but we have reached a bit of a plateau and we need to recognise as nurses that we have still got a job of work to do."
"The timing of the Stop the Pressure programme is very deliberate in terms of the work we still have to do and kickstarting it,” she said.
Jennie presented a generic case study, which she said could apply in any acute setting, to highlight why there was a need for the campaign.
"It's a study I'm sure any one of us could pull based on any number of patients we have met and treated throughout our own careers.”
She said: "The history of the programme has very much wanted to use the collective energy and enthusiasm of the whole workforce to move things forward.
"The whole ethos of how we are trying to drive this forward is changing, and it's important that it does, because making change is not something you can achieve top down,”Jennie said. "We've got to where we are be now and now we need to push and head home in terms of further improvement.”
She talked about the history of NHS Improvement, the organisations that came together to form it in April of this year, and the drive to lead genuine improvements in NHS care going forward.
She talked about the history of the Stop the Pressure, and its initial aims to create a significant culture shift with regards avoidable harm, harness the collective energy and competitive nature of the nursing workforce, provide focus and support to frontline staff to demonstrate their contribution to care excellence, to celebrate good performance, and to eliminate avoidable pressure ulcers.
"There are still some cultural things we need to do,” she said. "We still need to harness the energy of people who are not nurses and midwives. There's a real drive for us to engage with lots of medical groups.
"We also need to recognise the huge amount of work that is going on right across the board.
"There’s absolutely still a need to focus and support front line staff and there's still a need to celebrate performance."
"There's a huge amount of work, some of it quite groundbreaking,” she said. "There is such enthusiasm in the system to really move this agenda forward.
"Every day I'm getting emails from people saying 'how can I help' I wasn't to join the programme."
"One of the things that's reflected back to me as I go through these slides is, we have been having these conversations for a very long time, and now we as a central team really need to grab these knotty questions and get some answers."
Jennie Hall’s Full Presentation Click Here
Jennie Hall’s 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.
Monitoring progress against the NICE Quality Standard & Guideline for Pressure Ulcers and Implementing NICE Guidance for Pressure Ulcers
Professor Gerard Stansby Chair Guideline Development Group Prevention and Management of Pressure Ulcers Guideline and Quality Standard National Institute for Health and Clinical Excellence
- the Quality Statements: where are we now?
- implementing and monitoring adherence the standard in practice
- challenges and critical success factors
FOLLOWING the lunch break, Professor Gerard Stansby Chair of the Guideline Development Group for the Prevention and Management of Pressure Ulcers at the National Institute for Health and Clinical Excellence discussed the causes of pressure ulcers, as well as the risk factors around them.
He said the reason pressure ulcers were important was that an estimated 4-10% of patients admitted to an acute hospital develop them, that they are a major cause of sickness, reduced quality of life and morbidity, that they were associated with a 2-4 fold increase in risk of death in older people in intensive care units, the substantial financial cost they represent, and finally the medico-legal aspects associated with them.
He said: “In 2004, the estimated annual cost of pressure ulcer care in the UK was between £1.4billion and £2.1billion a year. The mean cost per patient of treatment for a grade IV pressure ulcer was calculated to be £10,551.
Gerard discussed the differences in definition between an ‘avoidable’ and an ‘unavoidable’ pressure ulcer, the percentage of which are avoidable, and where a pressure ulcer was avoidable, what questions we must still ask ourselves, including: Were the patient’s condition and risk evaluated at admission and at all stages of their care, was prevention planned, implemented, monitored and evaluated, and could interventions be revised as required.
He talked about the role of the multi-disciplinary team and quoted research that suggested, generally, doctors knew little about pressure ulcers and how to prevent them.
"I think we've got a bid of a divide between the medics and the other professions and probably tissue viability has a bit of a role to bring that back together,” he said.
Introducing the NICE guidelines, Professor Stansby said, they had been ‘quite difficult’ to get right.
"I think an expert nurse opinion is almost always as good as any tool or scale,” he said.
He talked about the scope and groups covered by the guidelines and the key clinical issues around prevention.
"There's a difference conceptually and practically between risk assessment and skin assessment,” he said. "Assessment and grading is really important.
“If someone can understand how you access the grade of an ulcer they will learn a lot about how you can prevent hem. I think it brings it home a lot."
He said in developing the guidance, NICE took the view in broad terms it would monitor risk in three categories, those ‘not at risk, those ‘at risk, and those ‘at high risk’ of developing a pressure ulcer.
"Conceptually that is quite a helpful approach because if you can pick out those very high risk ones you can often make the argument to put additional resource and capacity into those areas, where you might not be able to with very small groups of patients,” he said.
"I think the mission should be to make sure everyone knows about pressure ulcers and the basics about how to prevent them,” he said. "If you compare the number of pressure ulcers with a number of other things that cause harm, like DVT etc, then pressure ulcers almost always come out on top hardest and I think there is an argument that more resources could be diverted to them."
He talked about some of the challenges the NHS faced in the future around pressure ulcers.
"I think the community setting is particularly difficult in terms of resources and response times,” he said. “Also, in terms of information and advice, a patient going into hospital probably gets a envelope with 15 leaflets in.
"I think there's a lot of practical problems in that and probably a bit of information overload going on,” he said.
"We've got to empower patients about this,” he said. "With staff, training is easy but motivation is hard.
"We've got to make them really motivated. There's an element of pride here, in reducing pressure ulcers and keeping patients free from harm."
Professor Gerard Stansby’s Full Presentation Click Here
Professor Gerard Stansby’s Abstract:
Pressure ulcers (PU) are distressing events, caused when skin and the underlying tissues are placed under pressure sufficient to impair blood supply. They can have a substantial impact on quality of life, and have significant resource implications, with extended hospital stays and significant staff time devoted to treating them. The morbidity, economic implications and potential for prevention of PUs have made them an indicator of effective practice, recognized in the NHS Outcomes Framework 2015/16.
In recognition of the impact of PUs on mortality and morbidity, the National Institute for Clinical Excellence (NICE) have updated guidelines CG179: The prevention and management of PUs (2014). Its recommendations apply to any setting where NHS care is provided or funded and aim to reduce the incidence, and optimize the management of PUs in the interests of patient safety and clinical and economic outcomes.
Additionally NICE has issued Quality Standards (QS 89) in June 2015 focussed on prevention and based on CG179.
For effective change leadership is needed across and organisation. Key challenges include prevention in the community setting relating to resources and response times and how to empower patients and carers. Commissioners are increasingly focussing on PUs as a marker of poor care and using measures of PU prevention or occurrence in contracting arrangements and CQUINS.
Professor Gerard Stansby’s Biography:
Professor Gerard Stansby qualified from Cambridge University and Addenbrooke’s Hospital in 1982. He carried out many junior training posts in Cambridge and the East Anglian area before moving to the Royal Free Hospital as Lecturer in Surgery. In 1993, he went to St Mary’s Hospital in London as a Senior Clinical Vascular Fellow and, in 1994, became Senior Lecturer in General & Vascular Surgery at St Mary’s Hospital and Imperial College, London. In January 2000, he obtained his current position of Professor of Vascular Surgery at the University of Newcastle and the Freeman Hospital.
Professor Stansby is the author of more than 250 scientific articles and several books on venous and arterial diseases. He is president of the RSM Venous Forum and coordinating editor for the Cochrane Vascular group and several medical journals. He has been on the NICE VTE prevention group (CG92), Chair of the NICE Venous thromboembolism (CG142) and Pressure Ulcer guidelines (CG 179) and associated quality standards. He is vascular lead of the North of England network and Senate member. His other interests include undergraduate medical education and he is the author of a bestselling surgical text book for undergraduates.
Future events of interest:
Implementing the NICE Guidance & updated Quality Standard on Diabetic Foot Problems: Prevention and Management
Eliminating Heel Pressure Ulcers
7 December 2016