'Pressure ulcers will still be seen until basic care is right'
During the last 10 years, several evidence-based guidelines have been published that describe a range of preventative strategies to help health professionals reduce the burden of pressure ulcers.
Disappointingly, there is limited evidence to demonstrate they are embedded in clinical practice.
Since 2005, pressure ulcers stage 2 and above have to be reported as clinical incidents and are subject to root cause analysis. The risk of vulnerable patients acquiring pressure damage has become so urgent that in 2009, pressure ulcers became the focus of one of the High Impact Actions. As they move up the patient safety agenda, coroners see the presence of pressure ulcers as an indicator of unsafe and poor care.
So why do we continue to see recurrent and increasing problems with pressure ulcers?
We are seeing an upsurge in the prevalence of patients at risk of pressure ulcers, with an increase in the elderly and underlying risk factors such as diabetes and obesity. Demand for prevention is now out-stripping our ability to provide the expertise required. While most pressure ulcers are largely preventable, an increasing number of patients will develop an unavoidable pressure ulcer as defined by the Department of Health.
The health service often fails to get pressure ulcer prevention right. This is not surprising as it would seem many elements of fundamental care are absent or poorly delivered.
The recent damning Health Service Ombudsman report about the care of older people contains evidence of disturbing practice. Ageism may be another issue - we know the wellbeing and dignity of older people is not always considered by the NHS. Pressure ulcers may be seen as an inevitable outcome of old age and illness.
Technical advances have increased, perhaps at the expense of pressure ulcer prevention. For example, we have a vast range of sophisticated, pressure-relieving mattresses available in the market place. Some of these are being relied upon too heavily and the critical act of examining and caring for skin is being overlooked. We must start to work differently and get the essentials right before we immerse ourselves in technology.
A recent study has suggested a link between the value a nurse places on pressure ulcer prevention and the patient care that they deliver (Samuriwo, 2010). This provokes useful discussion around how we can engage with, and empower our workforce to deliver quality care for our patients.
Nurses across the UK have been making considerable progress in reducing the burden of pressure ulcers. Examples of quality improvement tools include the use of the SKIN bundle, which is a collection of interventions that are implemented for at-risk patients and hourly rounding. These involve nurses proactively visiting patients on an hourly basis, on top of their usual duties.
Examples of good practice can be found on the NHS Institute for Innovation and Improvement website at www.institute.nhs.uk.
These achievements must be celebrated and nurses should be shamelessly stealing any successful ideas and innovations that can help improve pressure ulcer care, without reinventing the wheel.
Judy Harker is wound healing and tissue repair nurse, consultant tissue viability, Pennine Acute Hospitals NHS Trust
Samuriwo R (2010) The impact of nurses’ values on the prevention of pressure ulcers. BritishJournal ofNursingTissue Viability Supplement;19: 15, S4-S14.
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