SH CP 121 Pressure Ulcer Preventin and Treatment Plicy Summary: Keywrds: Target Audience: This plicy lays ut the respnsibilities f bth staff and the Trust fr prtecting patients against harm frm tissue damage. The dcument identifies key staff grups t underline, that as an rganisatin, the assessment, preventin, treatment and recrding f pressure ulcers is an imprtant functin acrss the bundaries f clinical disciplines. Prcedures and assessments, pressure ulcer, pressure, ulcer, preventin, treatment. All staff wh assess r treat patients. Next Review Date: May 2021 Apprved & Ratified by: Patient Safety Grup Date f meeting: 20 th April 2017 Date issued: Authr: Directr: Caryn Carr, - Lead Tissue Viability Specialist Nurse Helen Neary - Assciate Directr f Nursing and AHP 1
Versin Cntrl Change Recrd Date Authr Versin Page Reasn fr Change 19/09/13 Guy Alexander 1 7 Additin f statement abut the staff requirements befre undertaking any sharp debridement technique Feb C Carr 4 4 Update n evidence 1.1, 1.2, 2.2 & 3.2 2017 Feb 2017 C Carr 4 5 3.3 Eurpean Pressure Ulcer Advisry Panel 4.1 change frm head f specialist nurse t Chief Nurse 4.3 change f title Feb C Carr 4 6 Must change t MUST 2017 Feb 2017 Feb 2017 5.1 update n evidence C Carr 4 7 5.3 In patients rder via SBS Oracle 5.4 Available n the Intranet 5.7 New re-wrding C Carr 4 8 13 wrk alngside audit team 6.0 Training requirements 10 References updated Reviewers/cntributrs Name Psitin Versin Reviewed & Date Caryn Carr Lead Tissue Viability Nurse April 2017 Tissue Viability Team Tissue Viability Nurse Specialists April 2017 Helen Neary Assciate Directr f Nursing and AHP April 2017 Patrick Carrll East ISD Integratin & AHP Lead April 2017 2
Cntents Sectin Title Page 1. Intrductin 4 2. Wh des this plicy apply t? 4 3. Definitins 4 4. Duties and respnsibilities 5 5. Main plicy cntent 6 6. Training requirements 8 7. Mnitring cmpliance 8 8. Plicy review 8 9. Assciated trust dcuments 8 10. Supprting references 9 Appendix 1 Training needs analysis 10 Appendix 2 Equality Impact Assessment Tl 11 3
1. Intrductin 1.1 Pressure ulcers are detrimental t patients in terms f their physical, psychlgical and scial well-being, resulting in pain and pr quality f life (Ellis, 2016). If pressure damage is identified and addressed at an early stage, it may be reversed (McCulugh, 2016). It is therefre the duty f healthcare prfessinals t prmte the preventin f pressure ulcers and reduce their ccurrence. The develpment f pressure ulcers is recgnised as key indicatr f the quality f care delivered (Lyder, 2006, NICE 2014) and a fundamental aspect f patient care (NHS, 2015). 1.2 The cst t the patient in terms f pain and suffering is immeasurable, recent estimated annual cst f the care f pressure ulcers, range frm 1.4 t 2.1 billin (4% f annual NHS expenditure) (Bennett et al, 2004). Fr an individual categry 1 is 1,214 t a categry 4 is 14,108 (Dealey, 2012 The increase in litigatin csts has the ptential t inflate this figure (Lyder, 2006). 1.3 This plicy is intended t establish a standardised apprach and framewrk fr healthcare prfessinals undertaking the care f patients with a pressure ulcer, r wh are at risk f develping ne. 1.4 The plicy and guidelines are based n current best practice statements, psitin dcuments, expert pinin, Natinal and Eurpean guidelines and research evidence where it exists. 2. Wh des this plicy apply t? 2.1 The cntents f Pressure Ulcer Preventin and Treatment Plicy apply t all clinical and cmmunity teams in all settings within Suthern Health Fundatin Trust (SHFT). 2.2 This plicy prvides a framewrk fr all staff wrking within the trust wh are directly r indirectly invlved with delivery f care. It is supprted by the lcal implementatin guidance based n the RCN Clinical Practice Guidelines (2005), the NICE Pressure Ulcer Risk Assessment and Preventin guidelines (2014), the Eurpean Pressure Ulcer Advisry Panel Classificatin f pressure ulcers (EPUAP) and the trust guidance n the principles f general wund management. 3. Definitins 3.1 The fllwing definitins are used thrughut this plicy SHFT NICE EPUAP RCN Suthern Health NHS Fundatin Trust Natinal Institute fr Health and Clinical Excellence Eurpean Pressure Ulcer Advisry Panel Ryal Cllege f Nursing 3.2 Definitin f a Pressure Ulcer: Pressure ulcers als knwn as pressure sres, decubitus ulcers and bedsres. Pressure ulcers are defined as: Lcalised injury t the skin and / r underlying tissue usually ver a bny prminence, as a result f pressure, r pressure in cmbinatin with shear. (EPUAP, 2014) 4
3.3 Pressure ulcers usually ccur ver bny prminence; hwever individual patients have unique risks assciated with multiple cmplex medical cnditins. Hlistic care must reflect a risk assessment f all pressure areas. It is recmmended that Pressure ulcers are classified using the Eurpean Pressure Ulcer Advisry Panel (EPUAP) pressure ulcer classificatin tl (NICE, 2005). 4. Duties and Respnsibilities 4.1 Chief Executive The Trust s Chief Executive has verall respnsibility fr ensuring that the Trust has rbust systems and plicies in place in respect f pressure ulcer preventin and treatment and training, and that these are implemented. The Chief Executive will sign annually the certificate f cmpliance t the NHS Executive. The Chief Executive is respnsible fr pressure ulcer preventin and treatment thrughut the Trust and is respnsible fr ensuring that this plicy n pressure ulcer preventin and treatment is implemented in every peratinal area f the Trust: A bard level directr is appinted t act n their behalf t ensure adequate structures are in place t ensure, s far is reasnable and practicable, the health, safety and welfare f staff, patients and all relevant persns affected by the Trusts undertaking: A Chief Nurse is appinted t advise the directr respnsible fr the management f pressure ulcer preventin and treatment n all matters relating t pressure ulcer preventin and treatment. The Trust shall prvide a training prgramme t all staff prviding direct patient care in rder t maintain their cmpetence in pressure ulcer preventin. The Trust shall ensure that pressure relieving devices are prvided t all patients assessed as requiring them. The Trust shall prvide apprpriate pressure reducing mattresses and seating t all inpatients. The Trust will prvide training t nurses n reprting pressure ulcers as a clinical incident n the Trust incident mnitring system (Safeguard) 4.2 Bard f Directrs The bard f directrs have the respnsibility f setting the strategic directin f the Trust and verseeing the implementatin f this plicy and bjectives including thse related t pressure ulcers. It is the bard f directrs respnsibility fr decisin making n the management f all clinical and gvernance risks within the rganisatin. 4.3 Assciate Directr f Nursing and Allied Health Prfessinals The Assciate Directr f Nursing and Allied Health Prfessinals is respnsible t the Chief Nurse fr: Pressure ulcer preventin and treatment risks, particularly t the rganisatin. Implementatin f the trusts pressure ulcer preventin and treatment plicy. 4.4 Tissue Viability Team The Tissue Viability Team will prvide advice and jint assessment t staff and patients where standard interventins have failed. The grup cmmit t remain updated with the latest clinical evidence and natinal guidelines n the preventin and treatment f pressure ulcers. 5
The grup will maintain up-t-date training prvisin in cnjunctin with the Learning Department Review the Trusts pressure ulcer preventin and treatment plicy and pressure ulcer preventin and treatment strategy at regular intervals. 4.5 Clinical Managers Respnsibilities All clinical managers will ensure that staff prviding direct patient care receives training and regular updates in pressure ulcer preventin and treatment. All clinical managers will ensure that they have a Tissue Viability Link Nurse in rder t enhance practice. All clinical managers will ensure that the staff are aware f the prcedures fr rdering equipment and selectin criteria fr pressure relieving equipment. Clinical managers are accuntable t the Trust Bard fr ensuring that all acquired pressure ulcers categry II IV (EPUAP) ccurring during the current episde f care are assessed and reprted using the Trusts reprting system. 4.6 Respnsibilities f all staff All healthcare prfessinals must cmplete a Skin Assessment, Risk Assessment and MUST Assessment n all new admissins t their caselad. They must update dcumentatin t shw that his has been cmpleted. See Pressure Ulcer Guidelines All healthcare prfessinals wh care fr patients at risk f pressure injuries r wh have an active pressure injury must insure that they receive apprpriate educatin and demnstrate cmpetency in preventin and, aetilgy and assessment and treatment f pressure injuries 5.0 Main Plicy cntent 5.1 Risk Assessment Risk assessment is undertaken by persnnel wh have undergne apprpriate training t recgnise the risk factrs that cntribute t the develpment f pressure ulcers and knw hw t initiate and maintain crrect and suitable preventative measures (NICE, 2014). Risk assessment tls shuld nly be used as an aide-memire and shuld nt replace clinical judgment. The prcess f assessment and dcumentatin is f greater value than the numerical scre generated by the tl, the risk categry shuld be used in cmmunicatin. The frmal risk assessment must be reflected in the plan f care. Any change in a client s cnditin resulting in new r increased intrinsic r extrinsic risk factrs shuld trigger a re-assessment (NICE, 2014). Nursing staff must have access t and be aware f the Natinal Guidelines; Pressure ulcer risk assessment and preventin, including the use f pressure-relieving devices (beds, mattresses and verlays) fr the preventin f pressure ulcers in primary and secndary care This guideline is available via the internet at: https://www.nice.rg.uk/guidance/qs89 5.2 Pressure Ulcer Classificatin Pressure ulcer classificatin/stage must be recrded using Eurpean Pressure Ulcer Advisry Panel (EUPAP) classificatin tl. See Pressure Ulcer Guideline fr tl 6
5.3 Equipment Availability See Hampshire Equipment Service (HES) Website fr details f equipment catalgue and rdering. In patients rder via SBS Oracle 5.4 Referrals t Specialist Services Patients with severe r nn-healing pressure injuries shuld be referred t the tissue viability team fr advice r a jint visit t ensure that the best available care is being given t the patient. Fr pressure injuries classified at grade 3 r 4 cntact the Tissue Viability Team fr advice and may require a referral t the tissue viability service. Available n the Intranet 5.5 Patient Educatin and Infrmatin Fr thse patients identified as at risk, the patient (r carer) must be ffered Suthern Health Fundatin Trust Hw t Prevent Pressure Ulcers leaflet, and this must be recrded in the patient s recrds. Infrmatin fr patients and carers is available n the Tissue Viability Webpages fr thse at risk and fr thse with Grade 1 classificatin pressure damage The patient shuld be infrmed f hw they can cntact a health care prfessinal if they have any cncerns. 5.6 Transfer f patients between care settings When patients mve between care settings, such as discharge t the cmmunity frm hspital r frm hme t a nursing hme, scrupulus care shuld be given t cmmunicating the needs f the patient with regards t pressure ulcers, pressure ulcer risk and the equipment they will need t maintain skin integrity. The skin assessment dcument shuld be cmpleted fr all transfers in and ut f caselad / ward. Pr quality discharges r admissins where the presence f pressure ulcers are fund t have nt been cmmunicated will be recrded as a clinical incident; as this may lead t develpment r deteriratin f ulcers. Planning f transfer must always include adequate assessment and dcumentatin f wunds, accurate cmmunicatin with the new care setting and equipment. Planning must allw sufficient time fr cmmunicatin and the prvisin f apprpriate pressure relieving equipment. 5.7 Reprting All pressure ulcers classified as Grade 2,3, 4 and Deep Tissue Injury need t be reprted via Ulysses Risk Management System All pressure ulcers classified as Grade 3 and 4 shuld be reviewed in line with the criteria in the Prcedure fr Reprting and the Managing f Serius Incidents (SI) Suthern Health Nn Clinical Prcedure 6 0, t identify if serius harm has ccurred t the patient by any act r missin ccurring as part f the care prvided by the Trust. 5.8 Audit and quality The SHFT Tissue Viability Team will review the reprts f pressure injuries frm the clinical incidence reprting system n a quarterly basis in rder t identify trends and prvide feedback t prfessinal teams. 7
The SHFT Tissue Viability Team will review the results f the abve in rder t review practice and infrm strategic plans. Standards f clinical practice and Quality Imprvement Plans will be agreed and implemented after cnsultatin and reviewed by senir staff within SHFT. The SHFT Tissue Viability Team will wrk alngside the audit team t supprt an audit t evaluate clinical practice against standards and expectatins laid ut in this plicy. 6.0 Training Requirements Pressure ulcer preventin and management training and educatin will be rganised by the SHFT Tissue Viability Team and Learning, Educatin and Develpment (LEaD). Please see Appendix 1 fr Learning and Develpment Training Needs Analysis. Learning needs can be identified by individual staff members by cmpletin f the Pressure Ulcer cmpetency dcument. Dates and details f training pprtunities will be published n the Trust s Intranet. Specific knwledge and skills required by healthcare prfessinals in the area f pressure ulcer preventin shuld include: Aetilgy f pressure ulcers Classificatin f pressure ulcers, and the use f tls Pressure ulcer risk assessment, and use f tls Skin respnse and inspectin Maintenance and imprvement f tissue tlerance in rder t prevent injury, selectin f apprpriate treatment ptins Preventin strategies Psitining and seating Equipment fr pressure relief and reductin Knwledge n reprting pressure ulcers n Ulysses 7.0 Mnitring cmpliance Element t be mnitred Pressure Ulcer Incidents Principles utlined in this plicy Lead Tl Frequency Reprting arrangements Caryn Carr Caryn Carr Clinical Audit Clinical Audit Annually Annually Annual reprt t relevant cmmittee Annual reprt t relevant cmmittee 8.0 Plicy review Every fur years 9.0 Assciated trust dcuments Pressure Area Care A guide fr patients Pressure ulcer risk assessment and preventin SHFT Pressure Ulcer Guidelines 8
10.0. Supprting References Bennett, G., Dealey, C. Psnett, J. (2004) The cst f pressure ulcers in the UK. Age and Ageing. 33. Pg. 230-235. Dealey, C. Psnett, J, Walker, A. (2012) The cst f pressure ulcers in the UK. Jurnal f Wund Care.21 pg 261-264 Ellis, M. (2016) Understanding the latest guidance n pressure ulcer preventin. Jurnal f Cmmunity Nursing. 30/4 (29-33). Eurpean Pressure Ulcer Advisry Panel (2014) Classificatin f Pressure Ulcers Fx, C. (2002), Living with a pressure ulcer: a descriptive study f patients experiences, British Jurnal f Cmmunity Nursing. 7(6; Supplement) S10-S22 Lyder, C. H. (2006). Litigatin. In Rmanelli, M (Ed), Science and Practice f Pressure Ulcer Management (Pg. 163 167). Lndn: Springer. McCulugh, S. (2016) Adapting a SSKIN bundle fr carers t aid identificatin f pressure damage and ulcer risks in the cmmunity. British Jurnal f Nursing. June 2016 (S19-S25) NICE (2014) The Preventin and Treatment f Pressure Ulcers Clinical Guideline 29, Lndn. NICE. NICE (2015) Quality standard, Lndn. NICE 9
Appendix 1: Training Needs Analysis If there are any training implicatins in yur plicy, please make an appintment with the LEaD department (Luise Hartland, Quality, Gvernance and Cmpliance Manager n 02380 874091) t cmplete the TNA befre the plicy ges thrugh the Trust plicy apprval prcess. Training Frequency Curse Length Delivery Methd Facilitatrs Recrding Attendance Prgramme Pressure Ulcer & Suthern Health Learning Management Psture Every 3 years 1 Day Instructr led training Tissue Viability System via LEaD Management Team Directrate Service Target Audience Strategic & Operatinal Respnsibility Tissue Viability Strategic lead Adult Mental Health All frnt line staff (registered/qualified clinical staff and unregistered clinical supprt staff) MH/LD/TQ21 Specialised Services Learning Disabilities All frnt line staff (registered/qualified clinical staff and unregistered clinical supprt staff) All frnt line staff (registered/qualified clinical staff and unregistered clinical supprt staff) TQtwentyne All frnt line staff (registered/qualified clinical staff and unregistered clinical supprt staff) ISD s Older Persns Mental Health All frnt line staff (registered/qualified clinical staff and unregistered clinical supprt staff) ISD s Adults All frnt line staff (registered/qualified clinical staff and unregistered clinical supprt staff) ISD s Crprate Childrens Services All N/A N/A 10
Appendix 2: Equality Impact Assessment The Equality Analysis is a written recrd that demnstrates that yu have shwn due regard t the need t eliminate unlawful discriminatin, advance equality f pprtunity and fster gd relatins with respect t the characteristics prtected by the Equality Act 2010. Stage 1: Screening Date f assessment: March 2017 Name f persn cmpleting the assessment: Caryn Carr Jb title: Tissue Viability Strategic lead Respnsible department: Tissue Viability Team Intended equality utcmes: Wh was invlved in the cnsultatin f this dcument? Suthern Health NHS Fundatin Trust Tissue Viability Team Please describe the psitive and any ptential negative impact f the plicy n service users r staff. In the case f negative impact, please indicate any measures planned t mitigate against this by cmpleting stage 2. Supprting Infrmatin can be fund be fllwing the link: www.legislatin.gv.uk/ukpga/2010/15/cntents Prtected Characteristic Psitive impact Negative impact Age The service will prmte equality f pprtunity fr all age grups The risk and prevalence f pressure ulcer develpment is knwn t be higher in the lder Disability Gender reassignment Marriage & civil partnership Pregnancy & maternity Race The lcatin f services will take int accunt the needs f disabled peple access and design. Risk assessments will cmprise f privacy and dignity fr the assessment prcess and reassessment f patients Suthern Health will respnd psitively t requests fr interpreting and translatin age grup Increased risk f develping a pressure ulcer due t immbility N negative impacts have been identified at this stage f screening N negative impacts have been identified at this stage f screening Assessment/Patient Educatin and Infrmatin: There may be a ptential adverse impact if a patient s first language is nt English. Religin Cultural beliefs will be acknwledged during the assessment prcess with particular regard t the remval f 11 Suth Asians are 6 times mre likely t have Type 2 Diabetes and this may impact n the risk fr the develpment f a pressure ulcer. Cultural and religius beliefs shuld be taken int accunt when deciding n cmpressin therapy as sme frms f
Sex Sexual rientatin clthing fr assessment purpses. religius wrships require individuals t be bareft fr prayer N negative impacts have been identified at this stage f screening N negative impacts have been identified at this stage f screening Stage 2: Full impact assessment What is the impact? Mitigating actins Mnitring f actins 12