TRUST BOARD 22 December 26 Nursing, Quality & Patient Experience Directorate TISSUE VIABILITY Update and Ambition Executive Summary The aim of the Tissue Viability Service is to provide specialist assessment and advice on complex and non-healing wounds, or wounds with an unusual aetiology. In addition the team also provide ongoing training and education on different aspects of tissue viability to ensure care is evidence-based and cost effective. A major part of the teams work is also to ensure patients receive the best possible care and that the care is delivered in line with the Nice and EUPAP (24) guidelines associated with reducing pressure ulcers. The team aim to be as visible as possible in the clinical areas so they can support the nursing teams.. Reduction in Pressure Ulcer Incidences. Since 22 we have continued to see a year on year reduction in stage 3 and 4 acquired avoidable pressure ulcers. Although there appears to have been an increase in stage 2 and SDTI s between September and October of this year this has not affected the stage 3 and 4 figures. This reflects the effectiveness of the Trusts pressure ulcer prevention strategies. 4 3 3 2 2 Total of All Stages of Acquired AVOIDABLE Pressure Ulcers Overall 6-7 Target Page of 7
6 Stage Acquired AVOIDABLE Pressure Ulcer 4 3 2 Stage 6-7 Target 2 Stage 2 Acquired AVOIDABLE Pressure Ulcer Stage 2 6-7 Target 2 Stage 3 Acquired AVOIDABLE Pressure Ulcer 6-7 Target Stage 3 Page 2 of 7
Stage 4 Acquired AVOIDABLE Pressure Ulcer 6-7 Target Stage 4 6 SDTI Acquired AVOIDABLE SDTI Pressure Ulcer 4 3 2 6-7 Target SDTI.2 The Tissue Viability Team continue to review systems and processes and have re energised ways to maintain the focus on cost effective pressure ulcer prevention. Some of the initiatives developed this year are as follows: Working closely with ICELS to review the equipment available to make cost savings. The outcome was the implementation of the new hybrid mattress. Development and implementation of innovative switch wheel tool to illustrate to staff alternative ways of dealing with non-compliance in relation to PU prevention. Re launched the Braden risk assessment tool and E learning package. Currently reviewing and revising then system one templates to enable staff to have easier access to documentation. Page 3 of 7
2. Development of new route cause analysis process 2. Currently the Tissue Viability Team within Local Partnerships confirm and challenge Stage 3 and 4 pressure ulcers and Suspected Deep Tissue Injuries (SDTI s) and support the Root Cause Analysis (RCA) process. This process has identified that the themes from the RCA s were often very similar and the process did not address the human factors that might have contributed to the pressure ulcer development. A new RCA process has been developed collaboratively with the community staff that will streamline the process and incorporate human factors. The new process is currently being piloted and will be rolled out across the Trust by April 27. 3. Offender health 3. The Tissue Viability Specialist Nurse within Offender Health continues to increase awareness of the national pressure ulcer agenda. There is increased awareness across the directorate which has led to an increase in the number of pressure ulcers identified. Work has continued with partnership agencies across Lincolnshire, Nottinghamshire and Yorkshire to provide access to appropriate pressure relieving equipment in a timely manner. 3.2 Leg ulcer management is a large part of the wound care delivered within OH. With greater access to training and development and an investment in automated ABPI equipment patients are assessed and placed in appropriate compression which improves patient outcomes. 3.3 Burns and scalds are a significant problem within the prison population. There are often issues arranging hospital escorts which are outside of the control of healthcare so a joint pathway between the Nottingham Burns Unit and the prisons within the East Midlands has been developed. Photographs of the patients burns are emailed securely to the Burns unit and via liaison with the outreach team patients have access to specialist support and advice without leaving the security of the establishments. The TVSN is currently in consultation with the Burns unit in Sheffield to replicate this service across the Yorkshire Cluster. 4. Numbers of referrals dealt with Apr-6 May-6 Jun-6 Jul-6 Aug-6 Sep-6 Oct-6 Nov-6 North 88 3 6 96 99 6 6 South 88 8 77 84 87 78 8 3 BHP 67 66 67 8 4 44 Page 4 of 7
Patients 4 2 8 6 4 2 Referrals 26 Apr-6 May-6 Jun-6 Jul-6 Aug-6 Sep-6 Oct-6 Nov-6 North South BHP The activity of the team remains consistent across all areas and they continue to be appropriately utilised by the clinicians for complex patients.. Number of staff trained. The Tissue Viability Team have a rolling training programme which has recently also been re energised, larger venues booked to enable increased attendance. The team are currently developing an E learning leg ulcer training package which will be available from April 27. This will make the leg ulcer training more flexible and allow greater access for staff. In addition the Tissue Viability administrator contacts attendees prior to training to maximise attendance and alert teams of spaces if available. Training April 26 - Current Each Course -Number of staff Total Pressure Ulcer Prevention Management 2 24 24 24 92 Leg Ulcer Management 9 9 3 2 76 Wound Care Management 9 27 27 3 93 Training April 26-Current E a c h C o u r s e Wound Care Management Leg Ulcer Management Pressure Ulcer Prevention Management 2 2 3 Number of staff Page of 7
6. Link Professional Days 6. The team maintain a robust link nurse system and currently have 73 link nurses across the Divisions. The service provides quarterly link nurse study days and also allows access to Highbury staff although the team are not contracted to provide the Tissue Viability service for that area. Link Professional Days - 26 Staff Attended Highbury Hospital April 26 38 Mike Harris Centre Rampton July 26 32 Highbury Hospital October 26 39 7. South Nursing Home Training 7. Within the south of the county the team provide 3 study days per year and are currently working closely with the continence team so that both services are able to deliver training on these days to maximise and enhance the training delivered. 7.2 Total of 99 care home staff have attended in 26 Nursing Home Study Days - 26 Care Home Staff Attended Duncan Macmillan House April 26 3 Duncan Macmillan House June 26 33 Duncan Macmillan House September 26 3 8. LPZ 8. LPZ is a European audit programme which puts care problems on the agenda and actually benefits care organizations and professionals by providing feedback on their performance. In addition, LPZ provides opportunities and possibilities for care homes to benchmark with comparable care organizations in the country and learn from that. It offers cues for optimizing basic care and leads to concrete improvement activities. 8.2 The Tissue viability team took part in this pioneering European audit programme in November 2. The data collected identified the prevalence of pressure ulcers and continence issues for around 3 care homes in the East Midlands. The team will repeated this Audit again in November 26 and will receive the results of the audit in Jan 27. 9. Wound Care Formulary Page 6 of 7
9. Members of the Tissue Viability Team have been involved in a large wound care project with neighbours in primary and secondary care NHS organisations across the East Midlands. This has now led to the implementation of a new wound care formulary which can be used for all areas across the organisation currently receiving their wound management products via direct supply. The benefits from this will be: Increased formulary compliance Increased patient experience Free up clinicians time Cash releasing savings across the region of up to.4 million 9.2 However not all areas across the organisation are using or are able to use this route for wound management products, work is currently under way involving clinicians and pharmacy representatives to ensure where wound management products are requested using prescriptions (FP) that they have access to the same formulary products. It is envisaged within early 27 that there will be one wound care formulary in use across the organisation.. Key Achievements in 26 In July 26 at the Patient Safety Congress the Tissue Viability Specialist Nurse from Bassetlaw won an International award for her work on the React to Red training package. A Tissue Viability Specialist Nurse was seconded to NHS England to help roll out the react to red training package in South Yorkshire. In May 26 a work developed by a Tissue Viability Specialist Nurse on the use of Topical Negative pressure was showcased in a poster format at a European Wound Care Congress in Lisbon. The Offender Health Tissue Viability Specialist Nurse presented her work on self-harm and the implications within OH at a national conference. Offender Health burns pathway presented as a poster presentation at both the British Burns Association and Wounds UK National conferences. A member of the Tissue Viability Team applied to Health Science network for funding to produce a moisture lesion training package for staff on prevention and treatment of moisture lesions. This is still work in progress but the aim is to develop a similar training package like the very successful React to Red package which is being used throughout the country.. Recommendations The Board are asked to note, comment on and accept this report. Page 7 of 7