Lisa Turley, lead tissue viability nurse at the Russells Hall Hospital in Dudley, explains how her team recently made improvements in the management of pressure ulcer care
With the introduction of High Impact Action: Your Skin Matters, and the target set out by CQUIN, we decided to look at how we could reduce the incidence of hospital acquired pressure ulcers in our hospital.
We set out to document and plan how we could slowly implement an improvement in pressure ulcers one ward at a time.
The first step was to set up a pressure ulcer discussion group. This identified a number of trends and helped us to agree our plan of action:
- Formulate and introduce new documents trust wide, including pressure ulcer prevention (including SKIN BUNDLE) and management documents
- Agree support from three deputy matrons
- Agree the release of one link nurse per ward, one day per week, allocated to tissue viability work
- Train link nurses in ‘cascade’ ward rounding
At the beginning of February we commenced the cascade training and set up a database to record how many staff had been trained. Then on Valentine’s Day we launched the ulcer prevention and management documents. Getting in to the spirit of the day, we delivered red and white balloons to every ward with details of the new documents attached and a poem: “Roses are red, violets are blue, a pressure ulcer, can be prevented by you”.
Next, we launched our “We Love Your Skin” campaign, and even managed to persuade our directors to be photographed. We used the photographs of at-risk pressure ulcer areas to explain that while in our care, our patient’s skin should stay healthy and pressure ulcer free. We then announced that these photographs were in fact of our trust directors and ran a competition to put a face to the body part. Finally, we released “reveal” pictures with the various directors explaining the importance of pressure ulcer prevention.
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.
With the link nurses’ help, we started to audit the use of the new documents. As we were aware that the equipment was used inappropriately at times and that this could lead to delays for those who needed it and increased costs, we also included an equipment selection chart in the documentation. The link nurses were asked to audit the equipment’s usage every week and found that after four months the number of specialist mattresses used inappropriately dropped from 25% to 8%. This decrease has enabled us to reduce the audit to bi-monthly.
Since implementing the changes we have seen a vast improvement in the quality of care we provide to our patients. Some 80.5% of staff were trained on pressure ulcer prevention, risk assessment and pressure ulcer staging. Now 92% of our patients have the correct mattress for their needs, and we can happily report that the incidence of pressure ulcers is decreasing.
The future and thanks
The pressure ulcer group and link nurses continue to meet on a weekly basis; we are always revaluating our aims and continually make improvements to our strategy.
I believe our success in making all these changes in three months is attributable to the trust’s support, assistance from three deputy matrons, releasing link nurses from their duties once a week and the contribution of the directors. The changes and improvements we’ve made would not have been possible without this support.
This is true multidisciplinary working!
Lisa Turley is the lead tissue viability nurse at the Russells Hall Hospital in Dudley.