Pressure ulcers are one of the most prevalent of all preventable harms that can occur both inside and outside the hospital setting. NHS England, NHS Improving Quality and Haelo have joined forces, along with other partners, on the national ‘Stop the Pressure’ campaign, first launched by NHS Midlands and East. Michelle Hope, a Quality Improvement Nurse and Darzi Fellow, provides an insight into her own role in pressure ulcer prevention at UCLPartners Academic Health Science Partnership:
Last year was a difficult one for nursing and the NHS as a whole with the Francis, Berwick and Keogh reviews and reports highlighting areas of concern.
This has been widely reported in the media and nurses bore the brunt of this negativity with headlines shouting out about failings and poor care. While it is true these failings did indeed occur and that we must learn from them and improve, the feeling at ward level is one of frustration. Most people take up a profession in nursing with an underlying desire to contribute something meaningful to society. However, somewhere along the line this compassion becomes lost among our many competing priorities.
Many initiatives are designed with the aim of getting nurses back to the bedside delivering basic care, and it is the responsibility of the ward sister to set the standard while building and maintaining morale. I recently discussed this with a colleague where we likened our role to a juggling act having 15 priorities on which to focus yet being unable to dedicate the required amount of attention to each.
One of these priorities is pressure ulcers; which can indicate a failure of care. My hope is to be able to turn this around and help nurses care by addressing blockers such as having too many pieces of documentation to complete, which in turn will free up nurses’ time to be at the bedside delivering basic care.
It is this dilemma which made the position of Quality Improvement Nurse – Darzi Fellow so attractive to me. I am currently on a 12 month secondment leading a project across University College London Partners (UCL Partners) to reach our ambitious aim of ‘eliminating acquired avoidable pressure ulcers across the partnership by December 2014’.
Nearly 700,000 people are affected by pressure ulcers each year, across all care settings, including patients in their own homes, with the most vulnerable of patients aged over 75. Around 186,617 patients develop a pressure ulcer in hospital each year, and each pressure ulcer adds over £4,000 in additional costs to care.
Pressure ulcers can be extremely uncomfortable and in severe cases can result in severe harm or even death. However, the vast majority of pressure ulcers are avoidable with the right procedures in place and when people are aware of what to do to prevent them.
Our pressure ulcers project at UCLPartners creates a shared community of committed caring professionals who will learn from each other’s successes and challenges. Members are encouraged to decide upon improvement strategies that will work in their organisation with a focus on sharing the learning rather than benchmarking against each other. Each member makes a commitment to measurement and sharing their data as we head towards our aim in a realistic manner.
The number of people involved with the project is growing each month with representation from the inpatient, community and nursing home settings. Much debate and discussion takes place at our monthly meetings about the many variables such as defining avoidable/unavoidable, device related injuries and moisture lesions, and in general we agree they are all harm and that our patients should not leave our care in a worse condition than they entered it.
We also recognise there are people living their lives in the community unknown to health care providers who are at risk and many do come into hospital with pressure ulcers. This highlights the need for a wider public awareness initiative similar to the ‘Stop the Pressure’ campaign which directs health care professionals and student nurses towards resources to aid them in pressure ulcer prevention.
We need to break the taboo of the privacy and dignity debate. It must become the norm that pressure areas are assessed at regular intervals both at home and in hospitals. There is a fine balance to be found in achieving this but it may contribute to a reduction in the issue of non- compliance which is a contributory factor.
Prior to applying for my current role, I had never heard of the Darzi fellowship as it is relatively new to nursing, with the previous focus being on providing doctors with leadership skills and education, with organisations committing to developing the leaders of the future. It is exciting for nurses to have the same opportunity to be guided, mentored and coached throughout the project to develop skills, whilst studying a Post Graduate Certificate in Leading in a Clinical Context.
Within three weeks of stepping away from the clinical role of the ward sister I had my first moment of clarity. This came as I reflected on my personal experience of using the SSKIN bundle, (a prevention bundle used in healthcare to address five elements; skin, surface, keep moving, incontinence and nutrition).
I suddenly realised I had always delivered the care ‘to’ never ‘with’ the patient. Having this space to reflect is a valuable opportunity which the Darzi fellowship has afforded me and I look forward to many more light bulb moments in the year ahead.
The ‘Stop the Pressure’ campaign:
Avoidable pressure ulcers are a key indicator of the quality of nursing care. Preventing them happening will improve all care for vulnerable patients. The ‘Stop the Pressure’ national campaign is a call to action to share ideas and create change together.
To find out more, go to: www.nhs.stopthepressure.co.uk