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Harnessing the power of cake

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Vanessa McDonagh used simple targets and rewards to motivate staff to prevent pressure ulcers

The starting points of eradicating pressure ulcers at University Hospitals Coventry and Warwickshire Trust were visualising pressure ulcer free days in clinical areas and rewarding staff with a slice of cake and a cuppa.

Tissue viability clinical nurse specialist Vanessa McDonagh set up a campaign to raise awareness of pressure ulcers and motivate wards and other clinical areas to become free of hospital-acquired pressure ulcers. Called the “100 Days Free” campaign, it motivated nurses to take control and ensure their areas were free of pressure ulcers for that length of time and beyond.

“We’ve always had CQUIN targets, but I wanted to find a way to make it more accessible and easier for nurses to visualise,” she says.

In the first phase, 27 wards and departments reached the 100 Days Free from pressure ulcers target. On 23 September, 19 wards and departments reached the 200 Day Free milestone.

On reaching the 100-day goal, wards were given coffee, cake and accreditation with badges and a certificate, motivating them to go for the next goal of 200 days.

“The certificate acted like a kitemark of quality, symbolising that the ward or department had reached a high standard in pressure ulcer prevention,” says Ms McDonagh.

“We secured some sponsorship. The incentive was coffee and cake, and us and the chief nurse making a fuss of the ward staff and saying ‘thank you’ and ‘well done’ - but sometimes the simplest ideas are the most effective, and this has really worked. We designed it to be this simple.”

Since the campaign started, nurses are constantly asking Ms McDonagh what number day they are at and how many days they have to go to get their 100 days.

“It’s created a real buzz,” she says.

“However, we do have to be strict, and when people do have a hospital-acquired pressure ulcer, we do make them start all over again. That can be disappointing for them, but we have to be fair and make sure they learn from what went wrong.”

One ward reached 87 days then got a pressure ulcer and another had one at day 157 but, says Ms McDonagh, “they got on top of why it happened”. Those that are doing well are sharing their practice with other wards.

Training is a big part of the campaign, but rather than intensive days, Ms McDonagh and her team of tissue viability nurses provide “power training”, where they give staff 10-minute bursts of education.

“Most people knew how to prevent pressure ulcers, so we just refreshed their knowledge, and focused on key points, such as assessment and skin elements. We also encouraged them to reintroduce intentional rounding.”

Not everyone was keen on the campaign or the intentional rounding, but once their benefits appeared, reluctance was soon eroded.

The buzz has been maintained with a Twitter account for sharing ideas (@TVN_UHCW). Ms McDonagh says that she is spreading the word to all trust areas using social media.

“We have well-established link with occupational therapists, midwives and other allied health professionals,” she says. “And we all share ideas. We had a full link work day and we used half of this to highlight some of the practice and areas that were achieving great things.

“We want to involve everyone, so we included the emergency department and clinical decisions unit. It’s not fair to ask them to reduce pressure ulcers, but they’ve had rewards for identifying patients who come into hospital with pressure ulcers, because they are uniquely placed to identify individuals at risk, and that has had a great impact.”

The campaign has reduced hospital-acquired pressure ulcers by 69.5% and saved £600,000.

“That’s not why we did it,” says Ms McDonagh. “We did it because we are passionate about harm-free care, but this is an amazing achievement.”

And it shows the power of a cup of tea and a slice of cake.

Jenni Middleton

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