Stop the Pressure Moving Forward Susan Bowler Professional Advisor Stop the Pressure
Pressure ulcers : a costly and avoidable harm In the NHS in England from April 2014 to the end of March 2015 25,000 patients were reported to have developed a new pressure ulcer (HSCIC) 6,000 pressure ulcers are newly acquired in hospital each month (HSCIC) Patients with pressure ulcers stay on average 25 days in hospital (Raleigh 2009) The cost of treating a pressure ulcer varies from 1,214 to 14,108. Costs increase with severity (Dealey, Posnett, Walker. 2012) Moisture from urinary or faecal incontinence or perspiration can lead to tissue maceration and skin breakdown (New Jersey Quality Institute Collaborative) 2
Key strands of Stop the Pressure NHS Midlands and East regional NO pressure ulcers launch Ambition: To eliminate avoidable grade 2, 3 and 4 pressure ulcers by December 2012. National quality indicator and part of operating framework. Identified newly acquired pressure ulcers as a key improvement area Using a care bundle to prevent pressure ulcers CQUIN linked to safety thermometer 3
The ambition Was to create a significant culture shift with regards avoidable harm Harness the collective energy and (healthy) competitive nature of the nursing workforce Provide focus and support to front line staff to demonstrate their contribution to care excellence Celebrate performance and support where necessary To eliminate avoidable pressure ulcers WHAT DID WE NEED TO DELIVER THIS?
Communications campaign 5 RMayNurseDir
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Pressure ulcers in acute settings nationally Pressure ulcer prevalence has reduced 18.4% from the baseline period of 4.9% of patients surveyed to 4.0%. This equates to a reduction from an average 4418 patients with any pressure ulcer on a single day within NHS care to 3853 patients. Pressure ulcer incidence has reduced 33.3% from the baseline period of 1.2% of patients surveyed to 0.8%. This equates to a reduction from an average 1102 patients with a new pressure ulcer on a single day within NHS care to 754 patients. 7
Pressure ulcers in non-acute settings nationally Pressure ulcer prevalence has reduced 26.7% from the baseline period of 6.0% of patients surveyed to 4.4%. This equates to a reduction from an average 5691 patients with any pressure ulcer on a single day within NHS care to 3432 patients. Pressure ulcer incidence has reduced 28.6% from the baseline period of 1.4% of patients surveyed to 1.0%. This equates to a reduction from an average 1255 patients with a new pressure ulcer on a single day within NHS care to 751 patients. 8
What else is the data showing us? In January 2016 4.4% of reported patients had a pressure ulcer = 8,224 patients The South region demonstrate the greatest improvements in acute settings (19.5 % reduction in the proportion of patients with any pressure ulcer & 39.8% reduction in the proportion of patients with a new pressure ulcer) London demonstrate the greatest improvements in non-acute settings (40.3% reduction in the proportion of patients with any pressure ulcer and 26.1 % reduction in the proportion of patients with a new pressure ulcer) Grade 2 has reduced by 22.2% from 3.6% to 2.8% Grade 3 has reduced by 8.3% from 1.2% to 1.1% Grade 4 has reduced by 14.3% from 0.7% to 0.6% But We are seeing a plateau and variation in organisations 9
Landielijke Pravelentiemeting Zorgproblemen (LPZ) Falls Pressure Ulcers Incontinence Malnutrition Intertrigo Physical restraints
Trying out the LPZ in the East Midlands 30 homes across Nottinghamshire & Derbyshire (489 residents) Mixture of nursing and residential (42% & 58%) Single snap-shot audit - extensive Pressure ulcers and incontinence Focus Group Study Models of collaboration Barriers and facilitators to implementation.
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Pressure ulcers the results The mean Braden score was 17 (+/- 3.5). 403 (82%) at high risk (Braden score <20) 60 pressure ulcers in 41 (8.4%) of residents. 80% of the pressure ulcers started in the care home. 66 (14%) of residents had a moisture lesion. 47 associated with mixed faecal and urinary incontinence 8 with urinary incontinence alone 4 with faecal incontinence alone 7 with transpiration.
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Our recent work Care Homes- Good work happening across England PROSPER 58 Nursing / Residential Homes enrolled so far. 40 more commenced Nov 2015 (cohort 4) 20% reduction in pressure ulcers across care homes 1 Care home 167 days free of PU and a second 200 days free Your Turn React to Red Coventry Health Economy 1,100 Care staff trained 74 Nursing and Residential homes received training and 4 accredited 20% reduction in grade 2 PU in the community 17
Website development Stop the Pressure Website was developed following a successful campaign Excellent functionality but required a refresh Expert working group have updated all the material relaunch planned Next steps Migration to NHSI website (Clinical Quality / Patient Safety Development of online education aids 18
19 It started with a Tweet..
Over 2000 Students have attended Stop the Pressure Student Conferences
Student SSKINs A group of students adapted the SSKIN tool to reflect a version for student nurses - a number of simple steps could make a difference to improving safety, quality and experience of care
Our Change Champions for the Future
Economic analysis of pressure ulcers Economic teams are carrying out an analysis of the economic benefits of further improving PU care. Includes the costs of treating PU, prevention, and what further impact could be achieved in reducing prevalence of PU s. Current costs of treating PU s are substantial; primarily from nursing time. Key factors in the analysis are: some PU s are clinically unavoidable or cannot be avoided due to the setting where they are acquired There is the possibility of a 40m total cost saving, based on current costs = 30m in the acute sector + 10m in the community sector The savings in this area are based only on analysis of reductions in pressure ulcers. It is very likely that that there would be savings from reductions in other harms.
Agree national definitions Proposed next steps From mapping, highlight variation and best performers- call for action to providers. Continue working with Care Homes Develop a new national campaign with public health awareness Look at establishing a model for a national in-depth PU audit preformed once a year similar to Welsh work. Full skin checks, education assessment Plan a wound care campaign in 17/18 Collaborate with National Procurement Work-stream Continue with Student Conferences educating our leaders of tomorrow 24
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