Jacqui Fletcher stresses that pressure ulcers are everyone’s business and that everyone need to do their bit to prevent them
While much effort has been put into developing core concepts such as the SSKIN Bundles and the Stop the Pressure initiative, implementation of these can only be successful with local adoption and adaption.
Many areas have generated a sense of local ownership using the Safety Cross to identify the size of the pressure ulcer problem at ward or clinic level. This allows them to map how many days they are pressure ulcer free in their own area (defined as having no new category 2, 3 or 4 pressure ulcers having developed in their care).
Others have focused on engaging staff and patients in prevention through pressure ulcer prevention (PUP) champions. Some areas use a puppy logo or image to signify patients who are at risk and have asked patients if they would like to select their own puppy as a way of opening the conversation about pressure ulcer prevention with the patient and their family and carers.
In recognition of the difficulties in busy clinical practice of attending formal education, power training sessions (lasting 5‑10 minutes) have been developed; these allow quick bursts of education to be delivered whenever time allows, for example during a handover. This quick-burst training is supported by previously prepared training materials.
Clinical staff at all levels have acknowledged the importance of preventing pressure ulcers. I recently heard of a support worker refusing to allow a consultant surgeon to take a patient into theatre until they had their “jelly pads” (pressure redistribution pads) in place. This takes genuine courage and commitment.
We are spending a huge amount of money, time and effort on counting pressure ulcers and preventing new ones from occurring. However, we need to remember that the surefire way of reducing the number of patients with pressure ulcers is to focus on healing the ones patients already have.
We also need to think about how we get GPs on board. We have seen many patients identified as having pressure damage via the 72-hour alert form (if they have been admitted to hospital with a category 3 or 4 pressure ulcer).
These patients will not have been seen by any community nursing staff, so have not been risk assessed or had interventions put in place. Is this unavoidable? Possibly, but many of them will have seen their GP, even if only for a repeat prescription or check-up so they have seen a health professional.
Pressure ulcers are everyone’s business. We need to ensure everyone takes it as seriously as the support worker in theatre, and does their bit to prevent what is often an avoidable harm.
Jacqui Fletcher is harm-free care lead, NHS Midlands and East.
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