Eliminating Avoidable Pressure Ulcers Jackie Stephen-Haynes Professor & Consultant Nurse in Tissue Viability ICO Conference Centre, London November 3 rd 2014
Aims and Objectives Introduction Reducing pressure ulcers in community settings Creating the culture Engaging staff in the elimination of avoidable pressure ulcers Learning in practice Our experience in Worcetershire
...So lets take a closer look....
Worcestershire Health & Care NHS Trust Always caring about you To promote health and wellbeing through the provision of high quality, innovative and cost effective services.
WH&CT We will always provide an excellent patient experience Our services will always be safe and effective We will work in partnership to improve the integration of health and care Our organisation will be efficient, inclusive and sustainable
Courageous Ambitious Responsive Empowering Supportive Care Compassion Competence Communication Courage Commitment
The WH&CT Tissue Viability Team 2014 WH&CT 3971 headcount 3112 WTE 35.9% Registered Nurses 20.7 Support roles 9.26% AHP
Strategic Vision Accountability Quality Care Plan Strategy Organisational Intentions Ambition STOP THE PRESSURE Safety & Avoiding Harm Action & Change Thursday 10 th September 2009 Prevention Elimination of the avoidable pressure ulcer
A strategy for the elimination of avoidable pressure ulcers in WH&CT 1. Education and staff development 2. Pressure reducing equipment 3. Shared Learning from Serious Incident Forum 4. Information/education for patients & carers in Pressure Ulcer Prevention 5. Safeguarding & Mental Capacity 6. Documentation & Assessment 7. Sharing/Use of Data 8.Patient experience 9. Clinical Audit/Effectiveness
We know where we are......where are we?
2013-2014 Safety thermometer data April 94.7 May 94.9 July 94.3 August 94.6 Sept 93.4 Oct 93.8 Nov 94.8 Dec 94.6 Jan 94.5 Feb 94.1 March 93.9 Aspirant 100% Performance target 95%
Triangulation... Data collection ELMS Ulysees Safety thermometer
r We are in the Red!
We have a BIG problem...
Education: training Needs Analysis Waterlow risk assessment SSKIN Equipment selection Documentation RN AHP HCA Competency Based Education
Skin care bundle :S.S.K.I.N. S Surface S- Skin K Keep Moving I Incontinence N Nutrition sequence of steps no component is eliminated (McCarron 2011)
Pressure reducing equipment strategy Deliveries: standard, 24 hour, & OOH Receive 36,664 referrals, supporting 16,168 patients with over 70,000 items 250 standard items: 10 Pressure reducing
Pressure relief> ICES activity CY November 12 to October 13 3,500,000.00 3,400,000.00 3,300,000.00 3,200,000.00 3,100,000.00 3,000,000.00 2,900,000.00 2,800,000.00 2,700,000.00 2,600,000.00 2,500,000.00 2,400,000.00 2,300,000.00 2,200,000.00 2,100,000.00 2,000,000.00 1,900,000.00 1,800,000.00 1,700,000.00 1,600,000.00 1,500,000.00 1,400,000.00 1,300,000.00 1,200,000.00 1,100,000.00 1,000,000.00 900,000.00 800,000.00 700,000.00 600,000.00 500,000.00 400,000.00 300,000.00 200,000.00 100,000.00 0.00 Dynamic Sum of Value equipment delivered 3,248,511.94 1,129,228.60 Sum of Value equipment collected 3,093,552.79 925,275.04 Sum of value purchased 233,409.31 257,115.05 Static
Appropriate seating??
SI forum Decision against advice Learning from RCA Safeguarding
Public Awareness
QUALITY
Number of Pressure Ulcers Reported Grade of Pressure Ulcers Reported from October 2013 to September 2014 and % and Number Acquired Within Our Care 1600 1400 1200 1000 54.2% 800 600 400 46.5% 200 31.6% 31.8% 0 Grade 1 Grade 2 Grade 3 Grade 4 Total Number Reported 38 1601 338 66 No. Acquired within our care 12 867 157 21
Number Of Pressure Ulcers Reported in September 2014 Community Hospital Acquired Pressure Ulcers reported in September 2014 10 9 9 8 7 6 5 4 3 2 1 1 3 3 5 6 1 3 3 4 4 2 0 Abbott Cottage Pershore Tenbury Lickey William Astley Number Acquired Within Our Care 1 3 5 1 3 2 Total Number of Pressure Ulcers Reported by Ward 3 9 6 3 4 4
Pressure Ulcer for Community Hospitals per 1000 occupied bed days (Rolling 12 Months) 31.1 12.2 9.1 9.2 7.5 6.6 5.9 4.9 5.7 0.8
A strategy for the elimination of avoidable pressure ulcers in WH&CT 1. Education and staff development 2. Pressure reducing equipment 3. Shared Learning from Serious Incident Forum 4. Information/education for patients & carers in Pressure Ulcer Prevention 5. Safeguarding & Mental Capacity 6. Documentation & Assessment 7. Sharing/Use of Data 8.Patient experience 9. Clinical Audit/Effectiveness
In August 2014, 70% of the pressure ulcers have been assessed as unavoidable. 3 grade 3 in September... Statistical process control (SPC) charts...7 or more consecutive points lying on the same side of the mean, implies a change in the mean of the process... In October we have achieved 7 consecutive points
C E L E B R A T E WORCESTERSHIRE 2014
Together we can achieve No Ulcers! N Nutrition & fluids O Observe skin U Up & walking: turn & position L Lift. Don t drag C Clean skin & Continence care E Elevate heels R Risk assess S Support surfaces
Email: J.stephen-haynes@nhs.net
Contact Details Rosie Callaghan Tissue Viability Nurse Stourport Health Centre 07717543046 Email: rosiecallaghan@nhs.net Jackie Stephen-Haynes Professor in Tissue Viability Professional Development Unit, Birmingham City University Consultant Nurse, Worcester Health and Care NHS Trust Mobile: 07775 792775 Email: J.stephen-haynes@nhs.net Jayne Allchurch Secretary Tissue Viability Stourport Health Centre 01299 879453 Email:Jayne.Allchurch@hacw.nhs.uk