Sally Roberts, assistant director of Nursing Quality and Safety at the NHS Walsall Primary Care Trust, tells us how her PCT recently ran a “Call for Action Day!” to help kick start a change in pressure ulcer management
In August 2010 the National Patient Safety Agency (NPSA) launched ‘The National Framework for Reporting and Learning from Serious Incidents requiring Investigation’. This stated that the development of a category 3 or 4 pressure ulcer requires a comprehensive Root Cause Analysis investigation. Implementation of this framework was fully supported and a process for reporting and recording all category three and four ulcers was adopted across the health economy, this included timely reporting by the nursing home sector.
Pressure ulcers represent a major burden of sickness and reduced quality of life for patients, and a psychological, physical and clinical challenge for NHS staff. New pressure ulcers are estimated to occur in 4–10% of patients admitted to acute hospitals in the UK, with the total cost in the UK estimated to be £1.4 - £2.1 billion annually, 4% of total NHS expenditure.
High Impact Action: Your Skin Matters calls for no avoidable pressure ulcers in NHS funded care. The aims of ‘Your skin matters’ include:
- Thinking about high risk patients – we all know risk is predictable
- Carrying out timely skin assessments
- Making sure the right equipment is available
- Improve nutrition and hydration and initiate and maintain suitable measures of how you are doing, using the expertise that is available to you: tissue viability specialists etc
Once reporting and recording process for pressure ulcer activity was embedded, the root cause analysis took place. This was in the form of a fifty-day closure meeting between senior clinical staff within the PCT where all analysis was fed back to the referring organisation and lessons learnt assurance was gained. After the first three months of analysis we expected that ulcer numbers would peak as lessons were learnt.However, this hasn’t been the case. Month on month numbers of category 3 and 4 pressure ulcers increased and more decisive action was required.
A senior nurse meeting identified a range of issues to be addressed in the management of pressure ulcers and the HIA provided the context in which we identified these issues. It was clear to all that the best way to try and address the issues identified was to capture good clinical engagement at care delivery level with a range of clinical nursing staff from across the health economy using HIA as the framework in which to identify the issues.
In order to gain and motivate the staff we had identified as most enabled to enact change we had a ‘Call For Action!’ day. Tissue Viability nurses within each organisation were identified to help co-ordinate our approach and support the day. The Energise for Excellence (E4E) framework provided the background and structure to enable us to demonstrate to nurses how they could effect and support change. The E4E also helped to de-mystify and clarify how nurses could make a difference by combining different aspects of their current knowledge base - an approach that we think will have biggest large impact.
What is Energise for Excellence?
Energise for Excellence (E4E) is a new initiative that aims to encourage nurses to implement continuous improvement. The nurses behind the scheme want 200,000 nurses to sign and pledge to make changes that will have a positive impact on care and quality. E4E is suggesting the following areas for improvement: getting staffing right, delivering care and improving patient and staff experience. The initiative wants to encourage nurses to measure the impact of any changes they have made so they can prove they have achieved tangible changes, and the judges will be looking for examples of this in the entries.
The ‘Call For Action’ day provided a platform for senior clinical nurses to gather and discuss the daily issues they face when dealing with pressure ulcers. An external facilitator, nationally recognised in the field, chaired the day giving the event credibility and providing additional motivation to those attending. The aim of the day was to help nurses who wanted to make a difference and it was structured so that all the attendees had a voice and were able to discuss and problem solves any issues they had. Outputs from the day included:
- All the attendees signing up to a declaration to address effective pressure ulcer management
- Action plans for improvement
- Identification of clinical champions
- Tthe of good sharing good practice
The buzz and conversation at the end of the day was inspiring. The attendees said that they felt energised and ready to make a difference, and that it was great to be asked how they could make a difference for a change, instead of being told how to.
It is still early days, but we have identified champions to take forward our plans, we will communicate the success of the day and lessons learnt to all stakeholders, there was evidence of effective networking across all clinical areas including the independent sector and opportunities to share best practice and collaborate as a result. Action plans will be developed and monitored for critical success factors.