Nurses need to find a balance between form filling and delivering care, and ensure that any data gathered on pressure ulcers is used to improve care
There are conditions that take centre stage in healthcare and there are those that remain on the sidelines. Pressure ulcers fall into the latter category. They don’t tug people’s heart strings, they can’t be cured by cutting-edge pharmaceuticals or revolutionary surgical techniques and we are not, to the best of my knowledge, on the cusp of life-changing research that will prevent them ever darkening our patients’ doors again with their messy, painful, odorous presence.
While “big name” conditions such as cancer and heart disease take the lion’s share of research funding, pressure ulcers remain neglected. Yet they affect so many people. They can occur regardless of age, sex or ethnicity. As many as 10% of patients in acute care will develop one (Clark et al, 2004). The impact on quality of life, length of stay and finance are well documented.
However, pressure ulcers have recently moved up the health agenda. The NHS Outcomes Framework 2012-13 includes a requirement to reduce the incidence of avoidable grade 2, 3 and 4 pressure ulcers, and financial penalties for avoidable pressure ulcers can now be imposed under commissioning agreements (Department of Health, 2011).
So, pressure ulcers are making some headlines at last, but to what gain? Patients still get them, although it’s not for the want of nurses trying to prevent them. Innovative nurses have worked tirelessly over the years to improve tissue viability care, and numerous courses, conferences and societies are devoted to this field.
A large part of the challenge for practitioners is to produce pressure ulcer statistics that are reliable enough to base sound clinical and financial decisions on. They need to look at who to include, how to grade accurately, how to determine root cause and how to adjust for national increases in contributory factors such as obesity and peripheral vascular disease.
There are areas producing good data, some of which demonstrates significant improvements in care, but this is down to local policy and practice and varies widely. Even when good data is produced, it is often either misused or not used at all. Take, for example, the ill-informed manager who compares prevalence with incidence data.
Most clinicians accept that the majority of pressure ulcers are avoidable. Preventive measures are relatively straightforward to implement with the right resources.
The problem is that much of the energy that once went into managing vulnerable patients goes into filling in forms about pressure ulcers instead. If the data isn’t used to change practice, the only impact it has is to take nurses away from where they are most needed: at the patients’ bedside.
We need to find a balance between form filling and delivering care and, most importantly, we mustn’t allow managers to dictate which takes priority.
Julie Vuolo is pre-registration link lecturer and programme tutor, international nursing, University of Hertfordshire
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Clark M et al (2004) The prevalence of pressure ulcers in Europe. In: Clark M (ed) Recent Advances in Tissue Viability. London: Quay Books, MA Healthcare.
Department of Health (2011) NHS Outcomes Framework - Renewed Focus on Improving Patient Results.