Agenda item A5(iv) THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST REDUCING HARM TISSUE VIABILITY PROGRESS REPORT EXECUTIVE SUMMARY The Tissue Viability Team assists wards and departments to reduce the numbers of pressure ulcers that develop in the Trust or to limit the depth of damage when these ulcers are unavoidable due to the patient being very sick. This paper describes the progress that has been made to reduce harm through a range of Trust-wide interventions led by the Tissue Viability Team. It also describes the ongoing development of the Tissue Viability Team and some of their achievements. MAIN ACHIEVEMENTS: The Tissue Viability Team has: Launched a high profile Time2Turn campaign of zero tolerance to pressure ulcers Developed teaching aids, care plans and assessment tools to assist wards develop their practice to achieve regular turning regime for their patients Enabled the Trust to achieve the target set for 2013-2014 to reduce the numbers of pressure ulcers by 25%, as measured by Safety Thermometer, and sustain that level for a period of six months (meeting the CQUIN targets and securing income of 675,000) Assisted the wards to achieve harm free days, ranging from 30 days to over 200 pressure ulcer free days Doubled output in terms of patients reviews and relentless staff training to empower staff to look after their patients in line with the Chief Nursing Officers 6C s i.e. courage, compassion, communication, care, competence and commitment. The importance of this work has been recognised by the Trust who are investing in the development of this team to ensure this harm reduction is continued, in order to further enhance patient care and support the achievement of this year s CQUIN target RECOMMENDATION To (i) note the content of this report (ii) comment accordingly. Helen Lamont Nursing & Patient Services Director Frances Blackburn Head of Nursing - Freeman Hospital Fania Pagnamenta Nurse Consultant (Tissue Viability) 17 th June 2014
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST DEVELOPING TISSUE VIABILITY 1. INTRODUCTION Tissue Viability posts started to emerge in the 1980s in order to manage the use of therapy beds and to ensure effective utilisation. From these early posts, the roles have developed to encompass wound care and offering expert advice to clinicians of all specialties. In the Trust, the Tissue Viability service leads: the management of pressure ulcer prevention and management the management of complex wounds therapy mattress provision and technological wound care products the establishment of the Wound Care Formulary the provision of a menu of tissue viability education for all health professions allied to nursing Tissue Viability is a Trust-wide corporate Patient Services function provided by autonomous Nurse Specialists working without direct medical supervision across acute and community settings. The Service also provides strategic leadership for a number of local, regional and national initiatives, currently their time is focused on the prevention of pressure ulcers, with therapy mattress allocation, leading the Time2Turn Campaign (a Trust developed initiative); developing and circulating educational material; monitoring pressure ulcer development; target key areas; reviewing and undertaking Root Cause Analysis and ensure Action Plans are followed. 2. THE TRUST POSITION The Nurse Consultant leads the team across Acute and Community Services. The remit of the Service is to provide expert advice to all clinical teams (acute and community) for patients with complex wound healing needs. The Nurse Consultant is supported by two Nurse Specialists in Community and two Nurse Specialists, and one Band 3 HCA in Acute. The team is supported by one Administrative Assistant, who works part-time. Funding for the second Nurse specialist in Acute has recently been supported by the Executive Team. 3. DEVELOPING TISSUE VIABILITY 3.1 Ward/Community Teams Development In Tissue Viability the approach is one of staff empowerment through education in theory and in practice. They teach and enable staff to take care of their own patient s wounds. This empowering strategy is essential to maintain skill and 1
knowledge across such a large organisation Trust, where 50% of all patients have a wound (surgical wounds, leg ulcers, pressure ulcers, skin laceration and such). 4. DEVELOPING TISSUE VIABILITY PRACTICE 4.1 Pressure Ulcers Pressure ulcers are very high on the national political agenda as the Chief Nursing Officer and NHS Medical Director have identified them as a key quality issue for the NHS. The National Patient Safety Agency (NPSA) is urging NHS organisations to work towards preventing all pressure ulcers. Quarterly board papers have been presented to illustrate the Trust s commitment to eliminate all Trust-acquired pressure ulcers. The Tissue Viability Team is key to assisting wards and department to reduce the numbers of pressure ulcers that develop in the Trust or to limit the depth of damage when these ulcers are unavoidable due to the patient being very sick. Time2Turn Campaign In January 2013 Tissue Viability launched a new campaign, Time2Turn, to encourage staff to turn patients rigorously, as the best strategy for pressure ulcer prevention is turning patients as often as possible. At times, hourly turns are necessary: this is time-consuming for staff on the ward and a change of ward routine is necessary to embed this practice. Therapy mattresses, heel booties and other equipment are great adjuncts but never replace good turning practices and good skin care. The team designed a new logo and a series of educational documentation, to include turning discs, turning cards, care plans, patient and carer education leaflets and posters: Since its implementation, we have achieved: a) 47.6% reduction in all Trust acquired pressure ulcers: - 92.8% of all Category III and IV (the deepest kind of damage) - 42.1% of all Category I, II and moisture lesions (see Appendix One) b) Achieved the 2013-2014 CQUIN targets and working towards achieving the 2014-2015 targets (a further 25% reduction) with significant financial implications for the Trust. Harm free days In order to support staff and teams in the difficult task to reduce pressure damage, the Tissue Viability team suggested that celebratory cookies were to be presented to those wards achieving harm free days targets. The formal presentation of the cookies as a token of appreciation for all the hard work wards have undertaken has achieved wonderful results, which to date include: 2
Ward 19 FH (100 days); Ward 16 RVI (60 days and then 100 days); Ward 44 RVI (60 days); Ward 46 RVI (100 days); Ward 12 FH (100 days); Ward 5 FH (60 days and then 100 days), Ward 13 FH (192 days); Ward 23 RVI (60 days); Ward 42 RVI (100 days); Ward 32 FH (150 days); Ward 5 RVI (100 days); Ward 2 FH (100 days); Ward 18 FH (30 days); Ward 30 RVI (30 days); Ward 15 RVI (100 days); Ward 41 RVI (100 days); Ward 16 FH (100 days)l, Ward 29 FH (100 days); Ward 35 NCCC (30 days); Ward 15 FH (30 days); Ward 20 FH (250 days) and Ward 17 FH (30 days). The criteria for achievement are very high as they include moisture lesions and any grade of pressure damage. Ward 5 FH receiving their cookies for achieving 60 days harm free care 4.2 Staff Education Beside pressure ulcers education, described above, Tissue Viability offers a range of training and clinical skills, such as leg ulcer assessment and management; compression bandages application; topical negative pressure and sharp debridement. Some of these courses are academically validated. 5. OUTPUT 5.1 Community The Community Tissue Viability Service, based at Newcastle Hospitals Community Health, Walkergate Centre offers clinical support to Newcastle Hospitals Community Health, its staff and patients, GP practices, both city hospices, plus the patients from 62 nursing and residential homes across the city. Since January 2014, 278 referrals have been received by the team and 208 patients have been visited. Visits are always undertaken with a member of the 3
District Nursing team: as District Nurses are lone workers they need support right where wound care takes place, i.e. in the patient s home. 5.2 Acute Since January 2014, 1506 patients were seen by the acute team, an average of 320 patients per month. Additionally, phone advice is given daily to a number of wards/department which is not quantified. Output has increased exponentially due to the pressures of pressure ulcer prevention, but also high visibility by the Tissue Viability team on wards allows for practice development and staff education and empowerment. Due to the ever expanding size of this organisation, new staff join the Trust and they need to be educated to our high standards of practice. 6. TISSUE VIABILITY TEAM DEVELOPMENT The Tissue Viability Team is a relatively small corporate team accountable to the Nursing and Patient Services Director via Head of Nursing, Freeman Hospital. In order to achieve this work it has been recognised that investment has been required and this has been supported by Trust Executive who have agreed recurrent funding for a Band 7 Nurse Specialist which will ensure the team can be visible across all sites and review patients in a timely manner, provide advice and support to ward. 6.1 Tissue Viability Role Development Tissue Viability roles must be fit for purpose and align with the Trust s strategy and patients ever changing needs. Therefore, the team is supporting the development of their Band 3 Heath Care Assistant to become a Band 4 Assistant Practitioner, by learning on the job and undertaking a Foundation Degree at the University of Teesside. Training will commence in September 2015, after a period of working as a Band 3 to develop core tissue viability skills. This is a new role for the Trust and to our knowledge, a first nationally. The Tissue Viability team is highly skilled, due to the autonomous nature of the role, working amongst all specialities without medical supervision. The Team are all educated to degree level, with the Band 7 at Masters level (or equivalent) and the Nurse Consultant is currently undertaking a Professional Doctorate (due to complete in January 2016). The community team are advanced nurse prescribers. 6.2 Succession Planning As the team is highly skilled and academically trained to an exceptionally high level, and also an aging workforce, talent spotting and succession planning is essential to the Team s future success. The three Band 6s were talent spotted from the link nurse group and following all due process successfully recruited to the team and are now in training. One member of staff is due to commence the Masters in Advanced Wound Healing and Tissue Repair at the University of Cardiff; one has just completed the Clinical Skills course and one has currently been working to develop skills in the business and 4
financial side of the role to achieve and maintain a cost-effective use of wound dressings at ward level. 7. SUMMARY Tissue Viability is a vibrant and expanding team that responds to the needs of patients, carers and staff as well as being astute in understanding the national and regional political agenda. Flexible and innovative, the team is not afraid of embracing new ways of working to maximise output. The team is well supported by Patient Services Senior Nursing Team, and also by the Executive Team when additional support is required. 8. RECOMMENDATION To i) receive the briefing and note the content and ii) comment accordingly. Helen Lamont Nursing & Patient Services Director Fania Pagnamenta Nurse Consultant (Tissue Viability) Frances Blackburn Head of Nursing Freeman Hospital 17 th June 2014 5
Appendix One PRESSURE DAMAGE NUMBERS BY CATEGORY 9 8 7 6 5 4 Cat III 3 Cat IV 2 1 0 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Table 1 a) Cat III and Cat IV demonstrating a significant reduction 80 70 60 50 40 30 20 10 0 Cat II ML Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Table 3 c) Cat II and Moisture Lesion demonstrating a consistent reduction 6