Maeve Hyland RGN,H Diploma in Wound Management and Tissue Viability, CNS Tissue Viability, Cavan & Monaghan Hospital.

Maeve Hyland RGN,H Diploma in Wound Management and Tissue Viability, CNS Tissue Viability, Cavan & Monaghan Hospital.

Improvement Collaborative for reducing Hospital Acquired Pressure Ulcers have proved successful (NHS Wales 2010, Visscher et al. 2013). Nurses positive attitudes towards pressure ulcer prevention has not been linked consistently with improved care (Moore & Price 2004). Research Evidence

Findings Positive Attitudes Adequate Knowledge Inadequate performance of pressure ulcer prevention Barriers Patients Condition Lack of time Lack of personnel Lack of knowledge Lack of agreed routine and continuity of care Lack of pressure redistributing surfaces Reference: Literature Review by Waugh (2014) of Attitudes of Nurses towards Pressure Ulcer Prevention

Prevalence ranges from 12.5 21% in the acute care setting (Moore & Pitman 2000, Jordan O Brien 2002). The Prevalence of Pressure Ulcers in Cavan General Hospital in Oct 2013 was 11%.

A large scale improvement healthcare collaborative. Supported by Quality Improvement Division (HSE) and RCPI, through National Quality Improvement Programme. Aim: To reduce the incidence of Avoidable Pressure Ulcers within the DNE region, by 50% over six months with an ultimate goal of reaching 0%.

February 2014 to September 2014. 31 bed Acute Medical Ward. Safety Cross and SSKIN bundle introduced. Overbed and PSAG board Green Hand sign to indicate the at risk patient. Risk assessment and Skin assessment within 6 hrs of admission. Education on Pressure Ulcer Prevention and Nutrition Assessment. Results: 70% reduction in HAPU.

Sustainability of Pressure Ulcer to Zero Collaborative

C&MH identified an increase in reports of HAPU. A QIP was developed by key stakeholders and presented to the Q&PS Executive Committee. A Pressure Ulcer Subgroup was formed, including DON to lead on implementing the QIP, Practice Dev, ADON, CNM s, OT, Q&PS Manager, Dietitian, and TVN. Education programme to commence for staff.

Lack of Education/Training for Staff. Lack of Equipment i.e. Weighing scales, measuring tapes. Pressure relieving mattresses- overlays in use. No Pressure Relieving cushions available. Poor nutritional screening, leading to delay in referral to dietitian. Quality of therapeutic diets/protected mealtimes. Low staff morale due to staff shortages/patient dependency levels.

CLINICAL EXPERTIS E Education for RGN s and HCA s began in Sept 2015. ½ day Pressure Ulcer Prevention Programme incl. Nutrition Education(4 CEU points). 59% Nurses and 63% HCA s trained to date. Safety Cross was introduced to each ward when agreed with ward manager. SSKIN bundle was introduced in November 2015.

CLINICAL EXPERTIS E The following areas have introduced SSKIN bundle: 2 Acute Medical Wards Short Stay Unit 1 Predischarge Ward 2 Rehabilitation Wards Compliance is 100%.

Challenges: Consistency in frequency of care delivery is not always achieved. All aspects of the SSKIN bundle are addressed at each episode of care but the constant frequency is a challenge (13.78% of 58 charts reviewed showed inconsistent frequency levels). The Safety Cross not completed consistently on one of the acute medical wards Nurses felt extra work in addition to existing workload with no extra resources. Achievements: One acute medical ward, one predischarge ward and two rehab wards are completing the Safety Cross daily. The Green Hand logo on the overbed sign highlights the patient at risk of pressure damage for multidisciplinary team. Hospital wide mattress Audit November 2015, and replacement of mattresses as required. Pressure relieving cushions purchased

Jordan O Brien, J. (2002). Pressure Ulcer Prevalence in an Acute Setting. Poster Presentation. European Wound Management Association Annual Meeting, Pisa, Italy. Moore, Z.,& Pitman, S. (2000). Towards establishing a pressure ulcer prevention and management policy in an acute hospital setting. The All Ireland Journal of Nursing and Midwifery 1, 7-11. Moore, Z.,& Price, P. (2004). Nurses attitudes, behaviours and perceived barriers towards pressure ulcer prevention. Journal of Clinical Nursing, 13, 942-951.

NHS Wales (2010) 1000 Lives Plus. Pressure Ulcer Safety Cross. tinyurl.com/safety-cross. Visscher M, King A, Nie AM, Schaffer P, Taylor T, Pruitt D, Giaccone MJ, Ashby M, Keswani S. A Quality-Improvement Collaborative Project to Reduce Pressure Ulcers in PICUs. Pediatrics131(6):1950-1960. Waugh SM,(2014) Attitudes of Nurses towards Pressure Ulcer Prevention: A Literature Review. MEDSURG Nursing 23(5),350-357.

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