Large differences in a key measure of nursing quality have been suggested by data from analysts, shared with Nursing Times and sister magazine HSJ.
The figures, prepared by health analytics firm Dr Foster, indicate considerable variation in the number of decubitus ulcers – commonly known as pressure ulcers - compared to the expected number.
The measure covered patients discharged after surgery and is closely associated with the quality of nursing care.
Pressure sores were one of the eight High Impact Actions for nursing and midwifery identified by the NHS Institute, which quoted research showing they were associated with an increased risk of secondary infection and large increase in the risk of death in older people in intensive care units.
The Department of Health recently considered designating grade three pressure ulcers, the second-most severe, as “never events”.
The relative risk rating was arrived at by comparing the actual number of ulcers observed from February 2010 to January 2011 to the expected number, using a regression model based on data from the 2009/10 financial year.
The five trusts recording the highest rates against their expected figure were: Warrington and Halton Hospitals Foundation Trust, Medway Foundation Trust, Southend University Hospital Foundation Trust, Royal Bolton Hospital Foundation Trust and West Hertfordshire Hospitals Trust.
Dr Foster director of research Roger Taylor said trusts would often not record pressure ulcers accurately.
He told Nursing Times: “Coding is also not clear around where the pressure ulcer was obtained. By publishing this data we hope to inspire trusts to improve coding in this area and to begin using ‘present on admission’ flags to help give a clearer picture of in-hospital care.”
Royal Bolton Hospital‘s deputy director of nursing Maria Sinfield said after the trust audited the 2009/10 data they found 41 per cent of cases had developed the ulcer before admission.
She said: “Of the remainder, we found issues with our recording of how severe or otherwise the ulcer was – one even included a patient whose nose was reddened by their spectacles.
“We have reinforced the importance of risk assessment on admission and appropriate care plans. We are making sure that recording is accurate and detailed. We have also recently spent around £1m on new beds for the hospital which have pressure relieving mattresses. “
Southend University Hospital’s director of nursing Sue Hardy said: “Although the relative risk appears high it is currently within upper and lower control limits. Not withstanding that, a full audit of the underlying data is being undertaken to identify any significant trends which are contributing factors, allowing us to understand and improve where necessary.”
A spokeswoman for Medway Foundation Trust said the analysis didn’t distinguish hospital and community acquired pressure ulcers.
She said: “There appears to be some discrepancies in the coding process which has resulted in the Trust’s performance in pressure ulcer management being negatively viewed. Following a hand search investigation where identified patients’ notes were viewed, the actual number of those patients that acquired pressure ulcers post surgery was 23, which is well below the target set of 36.4. Medway NHS Foundation Trust is working with Dr Foster to investigate the reasons for these discrepancies.”
A spokesman for Warrington and Halton FT said: “We’ve now completed a review of the coding we use and actions we are taking will ensure that our data will give a more accurate representation of pressure ulcer incidence at our hospitals in the future as these figures currently give a higher reading than is the actual case.
“Reduction of pressure ulcers is a key part of our strategy around quality and safety and prevention and reporting of ulcers has been strengthened at our hospitals over the last year. Looking at our own data, there were 41 grade three or four hospital acquired ulcers recorded during the full 2010-2011 year across all areas at the trust and have set a 30% reduction trajectory for this year.”