01.10.12
Zero tolerance of pressure ulcers
Source: National Health Executive Sept/Oct 2012
Managing pressure ulcers is thought to cost up to 4% of NHS spending: a gigantic sum for something that is so often avoidable. NHE spoke to NHS Borders tissue viability operational lead Elaine Peace and tissue viability coordinator Carol Jeffrey about the methods it has been using to dramatically reduce pressure ulcer incidence rates.
A tried-and-tested package of reforms aimed at reducing rates of pressure ulcers, pioneered in America and Wales among other places, was implemented at NHS Borders last year.
Results so far have been strongly encouraging: a 70% reduction in pressure ulcers developing for in-patients at the Borders General Hospital and a 75% fall in the board’s community hospitals.
The National Tissue Viability Programme was developed by the Scottish Government and Quality Improvement Scotland (now Healthcare Improvement Scotland), building on previous best practice and in conjunction with the National Association of Tissue Viability Nurses, Scotland (NATVNS).
NHS Borders had been a pilot site, but the new funding from the Scottish Government allowed a wider roll-out to all in-patient clinical areas and funding for two specialist tissue viability co-ordinators.
Carol Jeffrey, NHS Borders tissue viability coordinator, said: “NHS Borders’ number one corporate objective is patient safety, and we were aware that patients across the NHS and across the world are suffering preventable harm in the form of pressure ulcers.”
There was encouraging evidence, Peace said, showing that on the ward where the measures were piloted, it had been nearly a year since the last patient developed a pressure ulcer. “We had the evidence at that point, from the pilot, to say this actually makes a huge impact on the patient experience.”
But there were challenges too. Jeffrey said the major challenge to begin with was a complete lack of “robust data” and little insight into the problem. “Clinical areas didn’t really have ownership over it. They thought things weren’t too bad – but actually they were and they just weren’t aware of it.”
The staff workload at the time was heavy, due to other changes going on at the health board, she said, so it “was seen as another new bit of paperwork to fill in”.
“People didn’t quite fully understand that this actually did work – it was robust and was going to have clinical outcomes. Across the board, and across the world really, staff were not up-to-speed on grading pressure damage and recognising it quickly enough.”
So how did they make it work? Jeffrey said: “It was quite hard work! There was lots of support for the clinical staff, lots of education, perseverance at times. Examples where this package had already worked before helped show it was tried-andtested.”
She said ultimately, everyone from chief executive Calum Campbell down to hands-on, grassroots ward staff bought into the initiative. The better data, proving to clinical staff that there really was a problem, was a real spur. “The clinical staff really wanted to do the best for their patients, so that really motivated them to do something about it.”
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