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Cumbria nurses help reduce hospital pressure ulcers by 61%

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A leading nurse has said “continual push and motivation” from care staff is behind her trust’s success in slicing the number of patients experiencing pressure ulcers in hospital by 61% in two years.

Tissue viability nurse Fiona Kelly, of North Cumbria University Hospitals NHS Trust, said at the peak the trust was recording up to 58 pressure ulcers a month.

“I think it’s been that continual push and that motivation that’s led us to where we are now”

Fiona Kelly

To tackle the problem, staff were set a target in 2015-16 by the trust’s director of nursing to reduce this figure by 50% with zero tolerance to grade 4 – the most serious – pressure damage. 

The tissue viability team rose to the challenge and introduced a series of different interventions and as a result has seen a 61% reduction in hospital acquired ulcers.

Ms Kelly said the fall was only possible because all staff “got on board”. “It’s just been that sense of pride in what they have achieved that have carried things forward,” she told Nursing Times.

Ms Kelly, who is speaking out about the trust’s achievements to coincide with International Stop Pressure Ulcer Day, added: “I think it’s been that continual push and that motivation that’s led us to where we are now.”

“We know there is still a bit of work to do to embed that practice, but we know we are optimistic”

Fiona Kelly

The interventions were “tried and tested” during a rapid process improvement week carried out on one of care of the elderly wards and then shared across the rest of the trust.

Among the methods introduced included putting up clocks near beds to remind staff when patients needed repositioning, and tightening up procedures around nurse ward rounding.

As the tissue viability team is only made up of three people to cover two hospitals 40 miles apart, information was cascaded to the various wards by a link nurse team. 

“Obviously we can’t be everywhere all the time, so that link nurse programme, I think, has been really successful in pushing the improvements forward,” Ms Kelly said.

fiona kelly

fiona kelly

Fiona Kelly

Last year, the trust also introduced a staff award scheme as part of the drive, which Ms Kelly said had given workers “great pride in their achievements”.

The trust expanded mandatory pressure ulcer prevention training from just registered nurses to health care assistants because Ms Kelly said they were often “doing the bulk of the hands-on care for patients”.

Ms Kelly said the HCAs had been “absolutely fabulous in embracing the work”.

From April 2018, the training has also become compulsory for allied health professionals.

Staff have been encouraged to check patients’ skin on admission, on ward transfer and on discharge and complete a “body map” to spot any signs of pressure damage early.

Hand held mirrors have been distributed across the wards to help staff carry out checks. “It’s sometimes those gimmicky things people like, it’s something different,” Ms Kelly noted.

She added that staff had also become much better at “heel offloading” – making sure patients’ heels were not rubbing on mattresses.

Ms Kelly said the programme had contributed to a change of culture among staff. “I think at one point it was almost a bit of a fear factor if areas developed damage,” she noted.

“But it’s looking more constructively at lessons learnt and trying to look at if there was anything different we could have done – in some situation there is, in some situation there isn’t, but the whole ethos now in the trust is looking at lessons learnt and how those areas can be supported,” she said.

“By focusing on more effective ways to prevent pressure damage, we can help keep patients free from pain”

Ruth May

Ms Kelly said the team was “optimistic” about the progress so far and was now focusing on embedding the new ways of working and making further reductions to hospital acquired ulcers.

She said the achievement was all the more rewarding considering the current climate of staff shortages and rising complexities of care.

She added: “Like most trusts, we are challenged by the patient population by the number of comorbidities the patients have when they have been admitted to hospital, but certainly you know despite the challenge that we are facing and certainly with the level of staffing as well, we have still seen improvement in care.

“We are quite optimistic with the way things have gone, we know there is still a bit of work to do to embed that practice, but we know we are optimistic in the improvements we have achieved to date,” she said.

Despite more than two decades in the job, Ms Kelly is still fiercely passionate about her work.

“I’ve been in wound care now for 24 years and I can see patients now being admitted with significant damage and I still get really quite upset about, and you think if you ever lose that it’s time to move on to a different job,” she said.

“But just knowing that we’ve prevented as a trust so many patients from getting pressure damage compared to where we were a few years ago, it’s really quite significant,” she told Nursing Times.

To mark International Stop Pressure Ulcer Day, Ms Kelly and other staff from the trust have been spreading the message to the public in a local supermarket.

Ms Kelly added: “I think it’s one of the misconceptions in the public arena that people don’t realise how severe, how bad this damage can get, and how chronic this damage can become.”

Latest data shows 1,300 new pressure ulcers per month are occurring within the NHS.

NHS Improvement has recently embarked on a new “red dot” awareness campaign as part of ongoing efforts to tackle the issue, which has also included launching the National Wound Care Strategy alongside NHS England.

ruth may

ruth may

Ruth May

Wearable red dots have been sent out to NHS staff to spark conversations with patients and families about what can be done to prevent ulcers.

A red dot symbol is also being used on social media alongside the #StopThePressure hashtag.

Ruth May, executive director of nursing at NHS Improvement, said: “We have made great progress through the national campaign in supporting nursing, AHP and clinical staff in the NHS with tools and collaborative programmes focused on the prevention agenda and on effective diagnosis, measurement and treatment.

“By focusing on more effective ways to prevent pressure damage, we can help keep patients free from pain, with reduced complications, meaning we can often reduce the time they have to spend in our care, which benefits both patients and the health service alike,” she added.

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