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#stopthepressure
Lincoln
15th October
2013
Welcome
Professor Sara Owen
Pro-Vice Chancellor
University of Lincoln
Introduction
Lyn McIntyre
Deputy Nurse Director, Midlands and
East
Charlotte Johnston
Student Nurse, University of Lincoln
NHS Midlands & East

4
5

• New numbers trend

• Midlands and East

New grade 2, 3 and 4 pressure ulcers
Resources

6 NHS | Presentation to [XXXX Company] | [Type Date]
7 NHS | Presentation to [XXXX Company] | [Type Date]
The Swan’s Story
http://www.youtube.com/watch?v=IJ
8FEhE561Y&sns=em
Pressure ulcer
recognition and
prevention
Mark Collier
Tissue Viability Nurse
Consultant
United Lincoln Hospitals NHS
Trus...
PRESSURE ULCER RECOGNITION
AND PREVENTION..

United Lincolnshire Hospitals NHS Trust

Mark Collier, Lead Nurse/Consultant ...
Pressure Ulcers:
Current terminology?

• Bedsore
• Pressure Sore
• Decubitus Ulcer
• Pressure Ulcer
What term do you use/prefer?
What is a Pressure Ulcer?
‘A pressure ulcer is a localized injury to the
skin and/or underlying tissue usually over a
bony...
What is a Pressure Ulcer?
‘Ulceration of the skin due to the effects of
prolonged pressure, in association with a
number o...
Pressure
External pressure will be transmitted from the
skin to the underlying bone, compressing the
tissues, including th...
Shear
A parallel force, shear damage occurs when
deeper skin layers and skeleton move away from
the upper skin layers. Thi...
Friction
Friction results form is the skin rubbing
against another surface. Friction forces can
contribute to the developm...
Can you measure Pressure?..
‘a perpendicular load or force exerted on a
unit of area’
Bennett and Lee (1985)
Force
Pressur...
Potential Sites for Pressure Ulcers
• Bony prominences

• Consider
–
–
–
–

Oxygen masks
Catheters and tubing
Surgical app...
Factors that increase the risk of
developing a pressure ulcer
Variables - ‘evidence based’
• Age

• Nutrition

• Medical Condition

• Medical Interventions

• Peripheral Vascular
Disea...
Age
• Extremes of age
• The skin of elderly patients is thinner, drier
and less elastic increasing the risk of
damage.
• N...
Nutritional Status
• Dehydration and malnutrition lead to poorly
nourished, inelastic tissues that are more prone to
damag...
BMI
• Very thin patients have less fatty tissue over
the bony prominences to protect from
pressure.
• Obese patients may h...
Medical History
• Conditions causing reduced mobility & sensation.
• Terminal illness due to multi-organ failure, poor
nut...
Medication
• Anti-inflammatory drugs (including aspirin)
and steroids may prevent healing.
• Chemotherapy drugs may damage...
Reduced Mobility
• Inability to move self in order to relieve the pressure.
• Consider immobility/reduced mobility due to:...
Sensory Impairment/
Reduced Consciousness
• Unaware of the need to relieve pressure.
• Consider
–
–
–
–
–

Unconsciousness...
Moisture Lesions
• A combination of moisture
and friction may cause
moisture lesions in skin
folds.
• A lesion that is lim...
Incontinence
• Urinary and faecal incontinence cause
excoriation of the skin.
• Moisture causes maceration of the skin.
• ...
Skin Hygiene
• Excessive use of soaps will remove the
skin’s natural protective oils and dehydrate
it.
• Consider
– Skin c...
Cost of Pressure Ulcers?
Additional treatment / management costs
associated with an Orthopaedic patient with
one Grade 4 P...
© Mark Collier
SSKIN - what does it stand for?
•
•
•
•
•

S = Surface
S = Skin Inspection
K = Keep moving
I = Incontinence
N = Nutrition
Patient Support Surfaces available?

PRESSURE REDUCING?

PRESSURE RELIEVING?
Prevention and Management Support
Surfaces
• Static foam mattresses
• Huntleigh Rentals Contract
– Resource pack on intran...
Observation / Skin Assessment

© Mark Collier
Prevention and Management
Skin Inspection
• At least daily, frequency will depend on vulnerability
and condition of patien...
Risk Assessment Tools
NICE Guideline No.7 Pressure Ulcer Prevention
‘Whilst there is little evidence to support one tool
o...
Prevention and Management
Positioning
• Regular repositioning to
avoid pressure on bony
prominences and existing
pressure ...
Prevention and Management
• Use of appropriate patient support surfaces
• Skin assessment and good hygiene
• Evidence base...
Categories (Grading) of Pressure Ulcers:
GRADE 1

GRADE 2

GRADE 3

GRADE 4
© Mark Collier
Pressure Ulcer Categories
Category 1
• Non-blanchable
hyperaemia (of intact skin)
• Discolouration of the skin
• Warmth
• ...
Pressure Ulcer Categories
Category 2
• Partial thickness skin
loss or damage
involving the
epidermis andor the
dermis.

• ...
Pressure Ulcer Categories
Category 3
• Full thickness skin
loss involving damage
to or necrosis of
subcutaneous tissue.
• ...
Pressure Ulcer Categories
Category 4
• Extensive destruction
and tissue necrosis or
damage to bone,
muscle or supporting
s...
Deep Tissue Injury
• May appear as a purple,
deep bruise, often
mistaken for a Grade 1
pressure ulcer
• Skin is intact
• O...
© Mark Collier
Guidelines within ULHT for….
• Pressure Ulcer Prevention
• Equipment Provision (Support
Surfaces)
• Pressure Ulcer reporti...
Current ULHT Documentation
• Patient assessment/admission documentation
that incorporates all of the principles of SSKIN
•...
ANY QUESTIONS?
Living with a pressure
ulcer – a patient and
carer perspective
Brian and Yvonne Rawson
In conversation with
Delia Muir
Pat...
Living With a Pressure Ulcer – a patient and
carer perspective.
Brian and Yvonne Rawson - PURSUN UK
Delia Muir - Patient a...
PURSUN UK
• A network of people with some personal experience of pressure ulcers or
pressure ulcer prevention
• We work on...
Patient Stories
• Real life stories are powerful and can create a common focus

• Patients and their families are often th...
Brian and Yvonne’s Story
For more information contact:
Delia Muir (PPI Officer)
d.p.muir@leeds.ac.uk
www.pursun.org.uk
Twitter @PURSUN_UK
Or talk t...
Comfort Break
SSKIN mini quiz
Mark Collier
Tissue Viability Nurse
Consultant
United Lincoln Hospitals
NHS Trust
STOP THE PRESSURE...
SSKIN Mini-Quiz

United Lincolnshire Hospitals NHS Trust

Mark Collier, Lead Nurse/Consultant - Tissu...
Question 1

What does the second S of SSKIN
stand for?
• Surface (green)

• Skin Inspection (red)
Question 2

What is the prime function of an
alternating pressure mattress (APM),
such as a Nimbus III?
• Pressure reducti...
Question 3

Which of the following skin
discolouration is the most important
to identify and report when
inspecting a pati...
Question 4

How would you categorise?

• Pressure ulcer (green)
• Moisture lesion (red)
Question 5

All pressure ulcers are preventable?
• True (green)

• False (red)
Question 5: Answer
Hibbs, P. (1988) suggested that 95% of all
pressure ulcers are avoidable.
Although everybody would agre...
Question 6

Who is responsible for the
application of the principles that
underpin SSKIN in clinical settings?
• Everybody...
ANY QUESTIONS?
Impact of good
nutrition and hydration
on pressure ulcer
prevention and care
Dr Ailsa Brotherton
Director for Clinical
Eng...
Ailsa Brotherton

BAPEN Secretary
British Association for Parenteral and
Enteral Nutrition
A multi-disciplinary charity committed to raising awareness of
ma...
Malnutrition in the UK
PHYSICAL
Disease related
malnutrition

PSYCHOLOGICAL

Mobility

Depression/bereavement

Feeding

De...
Malnutrition is both a cause and a consequence of disease
Psychology –
depression & apathy
Poor breathing and
cough from l...
The Malnutrition Carousel
NURSING
HOME

PRIMARY CARE
 dependency
 GP visits
 prescription costs
 hospital admissions
C...
Nutrition support in
adults 2006
February 2006
The effectiveness of
Nutrition Support (Stratton et al)
10 RCT, n = 494;
RR 0.29 (CI 0.18 to 0.47)

30 RCT, n = 3258
RR 0....
NICE ONS and length of stay
Standardised Mean diff.
(95% CI)
% Weight

Study

{HARTSELL1997}

-0.32 (-0.83,0.20)

12.3

{P...
2013 - ??
Costs being recalculated

2007 - >£13 billion p.a.
Public expenditure
associated with disease
related malnutriti...
PRIMARY CARE
 hospital
 dependency
 GP visits
 prescription
costs
HOME
General population
(adults)
BMI <20kg/m2 : 5%
B...
The Challenge:

We know what
excellent
nutritional care
looks like
The BAPEN
Toolkit for
Commissioners
& Providers
2010

Malnutrition Matters
Meeting Quality Standards in
Nutritional Care

...
1) Identify those with malnutrition or risk of malnutrition by screening
e.g. BAPEN‟s MUST Tool and assessment as appropri...
 Reliability

is not
about what clinical care
should be given

 Reliability

is about the process
of ensuring patients g...
Local
Improvement:

Using standards and guidelines to drive quality
improvements in nutritional care
•Use the BAPEN toolki...
Royal Devon and Exeter
NHS Foundation Trust
have designed a highly
reliable electronic system
for nutrition screening
usin...
Trajectory Results Trust-wide

General Compliance with
MUST Screening at Weekly Review
100%
90%
80%
70%
60%
50%
40%
30%
20...
Screening alone is not enough

Design
systems to
screen all
patients using
„MUST‟

Develop
individualised
nutritional
care...
Now is the
time to deliver
good nutritional
care
in the UK to
deliver ‘harm
free’ and
eliminate
avoidable
pressure ulcers....
Student nurse
design for SSKIN
Charlotte Johnston
and student nurse
colleagues
University of Lincoln
#stopthepressurelincoln
#stopthepressure
SSKIN: For Students, BY Students.
University of Lincoln
S - Shadow
• Important to spend time shadowing a Tissue Viability Nurse:

- When do you need their expertise?
- Learn from...
S – Signs/Symptoms
• Understand and recognise the early signs of pressure ulcers or
potential/further damage:
- Start to f...
K - Knowledge
• As new guidelines are coming out, we know and understand how to apply
these in practice:
- Read, Read, REA...
I – Innovate/Implement
• If you have any ideas to improve practice, share it!
- If you observe something that could be imp...
N - NMC
• Nurses are accountable for all action:
- NMC Code of Conduct: YOU, as students, are accountable
for all action/k...
Change agents and
boat rockers
Video: Dr Helen Bevan
Introduced by
Lyn McIntyre
Deputy Nurse
Director, Midlands and
Ready, set -PLEDGE
Joe McCrea
Film maker and Strategic
Adviser
NHS Change Day
Lunch
……..and
pledge, pledge, pledg
e!
Tweets
Can we trend?
Lynnette Leman
Digital Communications
Officer
NHS Improving Quality
Unique individuals that received a
#stopthepressurelincoln tweet … 214,130
Total number of timeline deliveries… 1,610,570
...
Stop the pressure
and nutrition:
interactive session
Lyn McIntyre
Deputy Nurse Director
Midlands and East
Andy Yeoman
Focu...
Pressure ulcer conference
Lincoln University
15th October 2013
Introduction
• Each table will play either;
- The Nutrition Game

or
- Stop The Pressure Game

• Games last for 30 minutes...
The Nutrition Game
• 1 board
• 1 set of question
cards (face down)
• 2 counters
• 2 dice
• 1 sand timer
• 1 “Pee chart”
Starting to play
• Place counters on
board
• Roll dice; highest
score starts
• First team roll dice
and move counter
• Lan...
Answer questions
• Team answers
question (use timer)
• Correct answer
MOVE forward 2
squares
• Opposite team roll
dice and...
Up Straws & Down Carrots
• Land on the bottom
of a STRAW – move
UP
• Land on TOP of
carrot - move DOWN
• Do this before
an...
Winning
• Get to FINISH first
OR
• Closest to FINISH
Stop the Pressure Game
• 1 board
• 1 question pack
• 1 SSKIN question
pack
• 2 counters
• 1 dice
• 1 sand timer
• 10 SSKIN...
Stop the Pressure Game
• Place counter on
Start (green
square)
• Roll dice; highest
score starts
• First team roll dice
an...
Stop the Pressure Game
• Team answers
question (use timer)
• Correct answer
MOVE 2 squares
• Opposing team roll
dice and m...
Stop the Pressure Game
• Team LAND on an
SSKIN square
• Opposite TEAM picks
up a SSKIN question
card and reads out
the que...
Stop the Pressure Game
• Correctly answer
WIN an SSKIN token
• TEAM places SSKIN
token on board
Stop the Pressure Game
• Correctly answer
WIN an SSKIN token
• TEAM places SSKIN
token on board
• Place SSKIN token on
boa...
Stop the Pressure Game
• Correctly answer
WIN an SSKIN token
• Place SSKIN token on
board
• Collect 5 tokens to
WIN
• Faci...
Enjoy
www.stopthepressure.com
Making a difference
through practice led
pressure ulcer
research
Professor Jane Nixon
Deputy Director
Institute of Clinica...
Making a difference through practice led
pressure ulcer research

Jane Nixon PhD, MA, BSc(Hons) RGN
Professor of Tissue Vi...
Impact of Pressure Ulcers on QOL
QOL Conceptual Framework

Symptoms

Physical
Functioning

Psychological
Well-being

Pain ...
UK world leading pressure ulcer prevention
clinical research
Critical mass Australia, Japan, Germany, the
Netherlands, Bel...
Research areas/pathways- Leeds
Risk Factors
QOL

Living with a
PU

Pain

Living with PU

Severe Pu

Erythema
Imaging

Matt...
Pain and pressure ulcers
Living with a pressure ulcer
Qualitative study

Patients reported pain preceding PU development a...
Pain and pressure ulcers
Extent of pressure area related pain
Prevalence hospital and community populations

3397 hospital...
Pain and pressure ulcers

Is pain important in predicting Category 2 PU development?
Cohort study hospital and community p...
Severe PU
•
•

Inquiry style study (Laming Inquiry, 2003)
Innovative retrospective case study design to examine
whole syst...
Risk Assessment
Which of your patients are at risk?
Multiple risk factors – which risk factors are most important?
Only 0....
PU Risk Factor Systematic Review
Research Question:
Which risk factors are
independently predictive
of PU development in
s...
PU Risk Factor Systematic Review
Key Risk Factor Themes included:
 Immobility
 Skin condition
 Perfusion (including dia...
Risk Assessment Framework
Aim: to agree a pressure ulcer risk factor
minimum data set (MDS) to underpin the
development & ...
Consensus methods
Questionnaires
Face to face meetings

© CTRU 2013
Risk Factor Progression
15 Risk factor
domains & 46
sub-domains of the
systematic review
reduced to 26 risk factors
follow...
Initial draft of the RAF and underpinning MDS

© CTRU 2013
Pre-test - Focus Groups

© CTRU 2013
Take home messages
at your patients skin

Ask and listen to patients

Problem solve for complex patients
References
Pain
Briggs M, Collinson M, Wilson L, Rivers C, McGinnis E, Dealey C, Brown JM, Coleman SB, Stubbs N, Stevenson...
References
QOL
Gorecki C, Brown JM, Cano S, Lamping DL, Briggs M, Coleman S, Dealey C, McGinnis E, Nelson EA, Stubbs N, Wi...
Acknowledgement
PURSUN (Pressure UlceR Service User Network)
NIHR: This presentation presents independent research
funded ...
Student Competition to be launched
Student Rate £35.00 per day
On the couch:
an interview
Video: Dr Helen Bevan
Introduced by
Charlotte Johnston
Student nurse
University of Lincoln
6 c’s – aims, website
and Care Makers
Dr Ruth May
Chief Nurse NHS England
Midlands and East
and
Care Makers
Compassion in Practice
Progress and Developments
Presented by Ruth May
Regional Chief Nurse
NHS England (Midlands & East)
...
The Nursing Narrative

156 NHS England | Ruth May | Twitter:

RMayNurseDir
The Keogh Review
•

A limited understanding of and failure to genuinely listen to patients and staff

•

The lack of value...
Developing the culture of
compassionate care

158 NHS England | Ruth May |

RMayNurseDir
Our values and behaviours are at
the heart of the vision and all we do

Care

Compassion

Competence

Communication

Coura...
Six Areas for Action
Helping people to stay
independent, maximising well-being
and improving health outcomes

Working with...
The children’s community nursing team at Cambridgeshire Community
Services NHS Trust has been announced as the winner of N...
162 NHS England | Ruth May | Twitter:

RMayNurseDir
What are Care Makers?
• We are looking for individuals who can be ambassadors for compassion in practice
and who can demon...
How to become a Care Maker
• From mid-October applications can be downloaded from
http://www.nhsemployers.org/caremakers/P...
Tweets and Pledges:
how have we done?
Lynnette Leman
Digital Communications Officer
NHS Improving Quality
Joe McCrea
Film ...
Wrap
up, thanks, reflections
on the day and looking
to the future
Professor Sara Owen and
Charlotte Johnston
University of...
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
Stop the Pressure Lincoln - 15 October 2013
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Stop the Pressure Lincoln - 15 October 2013

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Presentations from the Stop the Pressure Lincoln event held for 500 student nurses and caremakers at The Engine Shed, Lincoln on 15 October 2013

This event supports Stop the Pressure, a campaign to raise awareness of pressure ulcers

The hashtag used at this event was #stopthepressurelincoln

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Stop the Pressure Lincoln - 15 October 2013

  1. 1. #stopthepressure Lincoln 15th October 2013
  2. 2. Welcome Professor Sara Owen Pro-Vice Chancellor University of Lincoln
  3. 3. Introduction Lyn McIntyre Deputy Nurse Director, Midlands and East Charlotte Johnston Student Nurse, University of Lincoln
  4. 4. NHS Midlands & East 4
  5. 5. 5 • New numbers trend • Midlands and East New grade 2, 3 and 4 pressure ulcers
  6. 6. Resources 6 NHS | Presentation to [XXXX Company] | [Type Date]
  7. 7. 7 NHS | Presentation to [XXXX Company] | [Type Date]
  8. 8. The Swan’s Story http://www.youtube.com/watch?v=IJ 8FEhE561Y&sns=em
  9. 9. Pressure ulcer recognition and prevention Mark Collier Tissue Viability Nurse Consultant United Lincoln Hospitals NHS Trust
  10. 10. PRESSURE ULCER RECOGNITION AND PREVENTION.. United Lincolnshire Hospitals NHS Trust Mark Collier, Lead Nurse/Consultant - Tissue Viability, United Lincolnshire Hospitals NHS Trust mark.collier@ulh.nhs.uk
  11. 11. Pressure Ulcers:
  12. 12. Current terminology? • Bedsore • Pressure Sore • Decubitus Ulcer • Pressure Ulcer What term do you use/prefer?
  13. 13. What is a Pressure Ulcer? ‘A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated. (EPUAP 2009)
  14. 14. What is a Pressure Ulcer? ‘Ulceration of the skin due to the effects of prolonged pressure, in association with a number of other variables’ (Collier 1995) ‘an area of localised damage to the skin which can extend to underlying structures such as muscle and bone. The damage is caused by a combination of pressure, shearing and friction forces and moisture’ (NICE, 2005)
  15. 15. Pressure External pressure will be transmitted from the skin to the underlying bone, compressing the tissues, including the smaller blood vessels, between these two structures. When prolonged this pressure can lead to inadequate blood supply and cause tissue death.
  16. 16. Shear A parallel force, shear damage occurs when deeper skin layers and skeleton move away from the upper skin layers. This causes stretching of the small blood vessels which, if unrelieved, will lead to inadequate blood supply leading to tissue death. For example when a patient slides down the bed the skin over the sacral area adheres to the bed sheets and remains in the sitting position as gravity forces the deeper underlying tissues and bone to slip down the bed.
  17. 17. Friction Friction results form is the skin rubbing against another surface. Friction forces can contribute to the development of pressure ulcers by causing the skin layers to separate forming a blister, or by compromising the intact nature of the skin. For example ill-fitting shoes or during poor moving and handling techniques, such as moving patients up the bed on a sheet .
  18. 18. Can you measure Pressure?.. ‘a perpendicular load or force exerted on a unit of area’ Bennett and Lee (1985) Force Pressure = --------------Surface Area
  19. 19. Potential Sites for Pressure Ulcers • Bony prominences • Consider – – – – Oxygen masks Catheters and tubing Surgical appliances Prosthesis
  20. 20. Factors that increase the risk of developing a pressure ulcer
  21. 21. Variables - ‘evidence based’ • Age • Nutrition • Medical Condition • Medical Interventions • Peripheral Vascular Disease (PVD) • Patient Support Surfaces • Drug Therapy • Care being Given
  22. 22. Age • Extremes of age • The skin of elderly patients is thinner, drier and less elastic increasing the risk of damage. • Neonates and young children are also at increased risk of skin damage because their skin is still maturing.
  23. 23. Nutritional Status • Dehydration and malnutrition lead to poorly nourished, inelastic tissues that are more prone to damage. • Consider – Likes and dislikes – Appetite – Chewing and swallowing difficulties – dentures, sore throat/mouth – Physical ability to feed themselves?
  24. 24. BMI • Very thin patients have less fatty tissue over the bony prominences to protect from pressure. • Obese patients may have difficulty moving and therefore repositioning to relieve pressure.
  25. 25. Medical History • Conditions causing reduced mobility & sensation. • Terminal illness due to multi-organ failure, poor nutritional status & immobility. • Conditions affecting the circulation and oxygenation of the blood. • Consider – – – – – Heart disease COPD and lung diseases Peripheral vascular disease Diabetes Anaemia
  26. 26. Medication • Anti-inflammatory drugs (including aspirin) and steroids may prevent healing. • Chemotherapy drugs may damage healthy tissues. • Sedative drugs may affect mobility and sensation.
  27. 27. Reduced Mobility • Inability to move self in order to relieve the pressure. • Consider immobility/reduced mobility due to: – – – – – – – – – – #’s Surgery Epidurals Traction Pain Paralysis CVA MS Arthritis Drains & tubing
  28. 28. Sensory Impairment/ Reduced Consciousness • Unaware of the need to relieve pressure. • Consider – – – – – Unconsciousness Sedation Spinal Cord Injury Diabetic neuropathy Neurological Conditions egg MS, CVA
  29. 29. Moisture Lesions • A combination of moisture and friction may cause moisture lesions in skin folds. • A lesion that is limited to the natal cleft only and has a linear shape is likely to be a moisture lesion. • Peri-anal discolouration / skin irritation is most likely to be a moisture lesion due to faeces.
  30. 30. Incontinence • Urinary and faecal incontinence cause excoriation of the skin. • Moisture causes maceration of the skin. • Consider – Barrier creams/films
  31. 31. Skin Hygiene • Excessive use of soaps will remove the skin’s natural protective oils and dehydrate it. • Consider – Skin cleansers
  32. 32. Cost of Pressure Ulcers? Additional treatment / management costs associated with an Orthopaedic patient with one Grade 4 Pressure Ulcer equals…. £40,000 Sterling Collier M (1993) Quality Report, Addenbrookes NHS Trust from £1,214 (cat 1) to £14,108 (cat IV) Dealey C, Posnett J et al (2012)
  33. 33. © Mark Collier
  34. 34. SSKIN - what does it stand for? • • • • • S = Surface S = Skin Inspection K = Keep moving I = Incontinence N = Nutrition
  35. 35. Patient Support Surfaces available? PRESSURE REDUCING? PRESSURE RELIEVING?
  36. 36. Prevention and Management Support Surfaces • Static foam mattresses • Huntleigh Rentals Contract – Resource pack on intranet • Nimbus III – alternating airflow, has heel guard • Breeze – low air loss, light weight patients • Aura cushion • Consider when to step down!
  37. 37. Observation / Skin Assessment © Mark Collier
  38. 38. Prevention and Management Skin Inspection • At least daily, frequency will depend on vulnerability and condition of patient • Pay particular attention to: – Areas of healed ulceration – Bony prominences • Look for – Discolouration – Redness that doesn’t blanche with light pressure – Blisters – Localised heat – Localised oedema
  39. 39. Risk Assessment Tools NICE Guideline No.7 Pressure Ulcer Prevention ‘Whilst there is little evidence to support one tool over another, there is evidence to suggest that an assessment process that incorporates a risk assessment tool improves the patients outcomes’ Which one do we use? WATERLOW (2005)
  40. 40. Prevention and Management Positioning • Regular repositioning to avoid pressure on bony prominences and existing pressure ulcers • Turning/30 degree tilt • Avoid direct contact between bony prominences to avoid friction and shear – consider use of pillows • Consider – Seating – Spinal injuries – Bariatric patients
  41. 41. Prevention and Management • Use of appropriate patient support surfaces • Skin assessment and good hygiene • Evidence based moving and handling practice • Nutrition • Hydration • Incontinence
  42. 42. Categories (Grading) of Pressure Ulcers: GRADE 1 GRADE 2 GRADE 3 GRADE 4 © Mark Collier
  43. 43. Pressure Ulcer Categories Category 1 • Non-blanchable hyperaemia (of intact skin) • Discolouration of the skin • Warmth • Oedema • Hardening
  44. 44. Pressure Ulcer Categories Category 2 • Partial thickness skin loss or damage involving the epidermis andor the dermis. • The ulcer is superficial and presents clinically as an abrasion or a blister.
  45. 45. Pressure Ulcer Categories Category 3 • Full thickness skin loss involving damage to or necrosis of subcutaneous tissue. • This may extend down to but not through the underlying fascia.
  46. 46. Pressure Ulcer Categories Category 4 • Extensive destruction and tissue necrosis or damage to bone, muscle or supporting structures with or without full thickness skin loss
  47. 47. Deep Tissue Injury • May appear as a purple, deep bruise, often mistaken for a Grade 1 pressure ulcer • Skin is intact • Occur over bony prominences • Tissue damage that occurs from the inside out • May quickly progress to Grade 3 / 4 pressure ulcers
  48. 48. © Mark Collier
  49. 49. Guidelines within ULHT for…. • Pressure Ulcer Prevention • Equipment Provision (Support Surfaces) • Pressure Ulcer reporting (PUNT) • Pressure Ulcer Management
  50. 50. Current ULHT Documentation • Patient assessment/admission documentation that incorporates all of the principles of SSKIN • Waterlow Assessment Tool • Tissue Viability Care Pathway • PUNT (e-reporting tool on intranet) • Wound Assessment and Management Chart
  51. 51. ANY QUESTIONS?
  52. 52. Living with a pressure ulcer – a patient and carer perspective Brian and Yvonne Rawson In conversation with Delia Muir Patient and Public Involvement Lead Institute of Clinical Trials Research University of Leeds
  53. 53. Living With a Pressure Ulcer – a patient and carer perspective. Brian and Yvonne Rawson - PURSUN UK Delia Muir - Patient and Public Involvement Officer, University of Leeds
  54. 54. PURSUN UK • A network of people with some personal experience of pressure ulcers or pressure ulcer prevention • We work on pressure ulcer related research projects • Our members are also involved in education and professional development projects
  55. 55. Patient Stories • Real life stories are powerful and can create a common focus • Patients and their families are often the only constant thing in their journey through services, therefore their perspective very valuable • We hope that hearing about the impact that a pressure ulcer can have will help to drive home important prevention messages
  56. 56. Brian and Yvonne’s Story
  57. 57. For more information contact: Delia Muir (PPI Officer) d.p.muir@leeds.ac.uk www.pursun.org.uk Twitter @PURSUN_UK Or talk to us over lunch
  58. 58. Comfort Break
  59. 59. SSKIN mini quiz Mark Collier Tissue Viability Nurse Consultant United Lincoln Hospitals NHS Trust
  60. 60. STOP THE PRESSURE... SSKIN Mini-Quiz United Lincolnshire Hospitals NHS Trust Mark Collier, Lead Nurse/Consultant - Tissue Viability, United Lincolnshire Hospitals NHS Trust mark.collier@ulh.nhs.uk
  61. 61. Question 1 What does the second S of SSKIN stand for? • Surface (green) • Skin Inspection (red)
  62. 62. Question 2 What is the prime function of an alternating pressure mattress (APM), such as a Nimbus III? • Pressure reduction (green) • Pressure relief (red)
  63. 63. Question 3 Which of the following skin discolouration is the most important to identify and report when inspecting a patient’s skin? • Blanching (green) • Non-blanching (red)
  64. 64. Question 4 How would you categorise? • Pressure ulcer (green) • Moisture lesion (red)
  65. 65. Question 5 All pressure ulcers are preventable? • True (green) • False (red)
  66. 66. Question 5: Answer Hibbs, P. (1988) suggested that 95% of all pressure ulcers are avoidable. Although everybody would agree that ALL avoidable pressure ulcers should be prevented, there is now evidence in the literature to suggest that around 43% of all pressure ulcers can be deemed to be avoidable. Dowie F, Guy H et al (2013) Are 95% of hospital acquired pressure ulcers avoidable? Wounds 9:3 16-22
  67. 67. Question 6 Who is responsible for the application of the principles that underpin SSKIN in clinical settings? • Everybody (green) • All healthcare professionals (red)
  68. 68. ANY QUESTIONS?
  69. 69. Impact of good nutrition and hydration on pressure ulcer prevention and care Dr Ailsa Brotherton Director for Clinical Engagement and Leadership NHS QUEST PMO
  70. 70. Ailsa Brotherton BAPEN Secretary
  71. 71. British Association for Parenteral and Enteral Nutrition A multi-disciplinary charity committed to raising awareness of malnutrition and options for nutritional treatment, along with consequent impacts on health outcomes, resource utilization, and health & social care budgets. BAPEN Malnutrition Matters
  72. 72. Malnutrition in the UK PHYSICAL Disease related malnutrition PSYCHOLOGICAL Mobility Depression/bereavement Feeding Dementia Swallowing Low activity Decreased organ reserve Specific disease Multiple drugs (taste) Alcohol SOCIAL Isolation Poverty
  73. 73. Malnutrition is both a cause and a consequence of disease Psychology – depression & apathy Poor breathing and cough from loss of muscle strength Liver fatty change, functional decline necrosis, fibrosis Impaired wound healing and susceptibility to pressure ulcers Impaired gut integrity and immunity Poor Immunity and infections Decreased Cardiac output Hypothermia – decline in all functions Renal function – limited ability to excrete salt and water Loss of muscle and bone strength – Immobility, falls, fractures and VTE
  74. 74. The Malnutrition Carousel NURSING HOME PRIMARY CARE  dependency  GP visits  prescription costs  hospital admissions CARE HOME malnutrition HOSPITAL SECONDARY CARE  complications  length of stay  readmissions  mortality HOME BAPEN Malnutrition Matters
  75. 75. Nutrition support in adults 2006 February 2006
  76. 76. The effectiveness of Nutrition Support (Stratton et al) 10 RCT, n = 494; RR 0.29 (CI 0.18 to 0.47) 30 RCT, n = 3258 RR 0.59 (CI 0.48 to 0.72) Controls Controls Treatment Treatment 0 10 20 30 Complications % 40 50 0 5 10 15 20 25 Mortality % >70% reduction in complications and >40% reduction in mortality 30
  77. 77. NICE ONS and length of stay Standardised Mean diff. (95% CI) % Weight Study {HARTSELL1997} -0.32 (-0.83,0.20) 12.3 {PEARL1998} -0.49 (-0.78,-0.21) 12.7 {REISSMAN1995} -3.00 (-3.45,-2.55) 12.4 Gist 2002 -0.03 (-0.39,0.33) 12.6 Gocmen 2002 -2.54 (-2.93,-2.15) 12.5 Burrows1995 -0.38 (-0.78,0.01) 12.5 Patolia2001 -2.08 (-2.53,-1.63) 12.4 Weinstein1993 0.11 (-0.25,0.47) 12.6 Overall (95% CI) -1.09 (-1.91,-0.27) -3.45185 0 3.45185 Standardised Mean diff.
  78. 78. 2013 - ?? Costs being recalculated 2007 - >£13 billion p.a. Public expenditure associated with disease related malnutrition 2003 - >£7.3 billion p.a Over 3 million individuals malnourished or at risk of malnutrition in the UK NICE Cost Saving Guidance places malnutrition as a potential large cost saving to the NHS
  79. 79. PRIMARY CARE  hospital  dependency  GP visits  prescription costs HOME General population (adults) BMI <20kg/m2 : 5% BMI <18.5kg/m2 : 1.8% Elderly: 14% SHELTERED HOUSING 10-14% of tenants Prevalence of malnutrition in the UK HOSPITAL 28% of admissions SECONDARY CARE  complications  length of stay  readmissions  mortality CARE HOMES 30-42% of recently admitted residents
  80. 80. The Challenge: We know what excellent nutritional care looks like
  81. 81. The BAPEN Toolkit for Commissioners & Providers 2010 Malnutrition Matters Meeting Quality Standards in Nutritional Care Ailsa Brotherton, Nicola Simmonds and Mike Stroud on behalf of the BAPEN Quality Group
  82. 82. 1) Identify those with malnutrition or risk of malnutrition by screening e.g. BAPEN‟s MUST Tool and assessment as appropriate 2) Implement „individualised‟ care pathways for the malnourished and those at risk, appropriate to the care setting 3) Provide training for all care staff on the importance of nutritional care appropriate to setting, profession and responsibilities 4) Ensure multidisciplinary structures to manage and monitor nutritional care ...but we struggle to deliver these reliably
  83. 83.  Reliability is not about what clinical care should be given  Reliability is about the process of ensuring patients get best care consistently „Every patient, every setting, every day‟
  84. 84. Local Improvement: Using standards and guidelines to drive quality improvements in nutritional care •Use the BAPEN toolkit which simplifies the plethora of standards and guidelines for improving nutritional care • Design systems based on the four tenets of nutritional care • Embed good nutritional care into everyday work flow • Use evidence based tools and e-learning to support front line staff • Work across organisational boundaries to ensure seamless nutritional care • Ensure Trust Board Level engagement •Identify a BAPEN rep in your organization
  85. 85. Royal Devon and Exeter NHS Foundation Trust have designed a highly reliable electronic system for nutrition screening using ‘MUST’ MUST Compliance Mark Bellas Divisional Lead Nurse Critical Care/T&O
  86. 86. Trajectory Results Trust-wide General Compliance with MUST Screening at Weekly Review 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May10 10 10 10 10 10 10 10 10 10 10 10 11 11 11 11 11 Position Target
  87. 87. Screening alone is not enough Design systems to screen all patients using „MUST‟ Develop individualised nutritional care plans Design reliable systems to deliver care plans Monitor ongoing nutritional intake / status
  88. 88. Now is the time to deliver good nutritional care in the UK to deliver ‘harm free’ and eliminate avoidable pressure ulcers. “You may never know what results come of your action, but if you do nothing there will be no result” Mahatma Gandhi
  89. 89. Student nurse design for SSKIN Charlotte Johnston and student nurse colleagues University of Lincoln
  90. 90. #stopthepressurelincoln #stopthepressure SSKIN: For Students, BY Students. University of Lincoln
  91. 91. S - Shadow • Important to spend time shadowing a Tissue Viability Nurse: - When do you need their expertise? - Learn from their experiences. - Your responsibility to arrange to spend an insight day with TVN’s to supplement your university learning. 36. You must ensure any advice you give is evidence-based if you are suggesting healthcare products or services. NMC UK, The Code of Conduct: Professional Standards for Nurses and Midwives, http://www.nmc-uk.org/Documents/Standards/The-code-A420100406.pdf Date Accessed: 07/10/2013
  92. 92. S – Signs/Symptoms • Understand and recognise the early signs of pressure ulcers or potential/further damage: - Start to form a care plan and ensure appropriate action is taken. - To educate the patient and their families in ways to prevent potential/further damage. - Also improves patient-centred care – by improving nurse-patient communication. 54. You must act immediately to put matters right if someone in your care has suffered harm for any reason. NMC UK, The Code of Conduct: Professional Standards for Nurses and Midwives, http://www.nmc-uk.org/Documents/Standards/The-code-A420100406.pdf Date Accessed: 07/10/2013
  93. 93. K - Knowledge • As new guidelines are coming out, we know and understand how to apply these in practice: - Read, Read, READ! - Challenge yourself and develop your own best methods of nursing based on your own evidence-based research. - Training doesn’t stop at the end of a module, end of the year or the end of training. 40. You must keep your knowledge and skills up to date throughout your working life. NMC UK, The Code of Conduct: Professional Standards for Nurses and Midwives, http://www.nmc-uk.org/Documents/Standards/The-code-A420100406.pdf Date Accessed: 07/10/2013
  94. 94. I – Innovate/Implement • If you have any ideas to improve practice, share it! - If you observe something that could be improved on, go and speak to your mentor/ward manager. - Be the change you want to see. 22. You must work with colleagues to monitor the quality of your work and maintain the safety of those in your care. NMC UK, The Code of Conduct: Professional Standards for Nurses and Midwives, http://www.nmc-uk.org/Documents/Standards/The-code-A420100406.pdf Date Accessed: 07/10/2013
  95. 95. N - NMC • Nurses are accountable for all action: - NMC Code of Conduct: YOU, as students, are accountable for all action/knowledge you have - This is equally important for all healthcare professionals regardless of level, branch or speciality. Page 1: We exist to safeguard the health and wellbeing of the public. NMC UK, The Code of Conduct: Professional Standards for Nurses and Midwives, http://www.nmc-uk.org/Documents/Standards/The-code-A420100406.pdf Date Accessed: 07/10/2013
  96. 96. Change agents and boat rockers Video: Dr Helen Bevan Introduced by Lyn McIntyre Deputy Nurse Director, Midlands and
  97. 97. Ready, set -PLEDGE Joe McCrea Film maker and Strategic Adviser NHS Change Day
  98. 98. Lunch ……..and pledge, pledge, pledg e!
  99. 99. Tweets Can we trend? Lynnette Leman Digital Communications Officer NHS Improving Quality
  100. 100. Unique individuals that received a #stopthepressurelincoln tweet … 214,130 Total number of timeline deliveries… 1,610,570 Total number of tweets… 1,420
  101. 101. Stop the pressure and nutrition: interactive session Lyn McIntyre Deputy Nurse Director Midlands and East Andy Yeoman Focus Active Learning
  102. 102. Pressure ulcer conference Lincoln University 15th October 2013
  103. 103. Introduction • Each table will play either; - The Nutrition Game or - Stop The Pressure Game • Games last for 30 minutes • Each table splits into 2 teams
  104. 104. The Nutrition Game • 1 board • 1 set of question cards (face down) • 2 counters • 2 dice • 1 sand timer • 1 “Pee chart”
  105. 105. Starting to play • Place counters on board • Roll dice; highest score starts • First team roll dice and move counter • Land on square; opposite team picks up a question card
  106. 106. Answer questions • Team answers question (use timer) • Correct answer MOVE forward 2 squares • Opposite team roll dice and move • Repeat as before
  107. 107. Up Straws & Down Carrots • Land on the bottom of a STRAW – move UP • Land on TOP of carrot - move DOWN • Do this before answering a question
  108. 108. Winning • Get to FINISH first OR • Closest to FINISH
  109. 109. Stop the Pressure Game • 1 board • 1 question pack • 1 SSKIN question pack • 2 counters • 1 dice • 1 sand timer • 10 SSKIN tokens
  110. 110. Stop the Pressure Game • Place counter on Start (green square) • Roll dice; highest score starts • First team roll dice and move counter • Land on square; opposing team reads out a question
  111. 111. Stop the Pressure Game • Team answers question (use timer) • Correct answer MOVE 2 squares • Opposing team roll dice and move • Repeat as before
  112. 112. Stop the Pressure Game • Team LAND on an SSKIN square • Opposite TEAM picks up a SSKIN question card and reads out the question
  113. 113. Stop the Pressure Game • Correctly answer WIN an SSKIN token • TEAM places SSKIN token on board
  114. 114. Stop the Pressure Game • Correctly answer WIN an SSKIN token • TEAM places SSKIN token on board • Place SSKIN token on board
  115. 115. Stop the Pressure Game • Correctly answer WIN an SSKIN token • Place SSKIN token on board • Collect 5 tokens to WIN • Facilitators will help and break up any fights
  116. 116. Enjoy
  117. 117. www.stopthepressure.com
  118. 118. Making a difference through practice led pressure ulcer research Professor Jane Nixon Deputy Director Institute of Clinical Trials Research University of Leeds
  119. 119. Making a difference through practice led pressure ulcer research Jane Nixon PhD, MA, BSc(Hons) RGN Professor of Tissue Viability and Clinical Trials Research Clinical Trials Research Unit School of Medicine University of Leeds © CTRU 2013
  120. 120. Impact of Pressure Ulcers on QOL QOL Conceptual Framework Symptoms Physical Functioning Psychological Well-being Pain & Discomfort Mobility Mood Exudate Daily activities Anxiety & Worry Odour General malaise Self-efficacy & Dependence Sleep © CTRU 2013 Social Functioning Appearance & selfconsciousness Source: Gorecki, C et al Isolation Participation
  121. 121. UK world leading pressure ulcer prevention clinical research Critical mass Australia, Japan, Germany, the Netherlands, Belgium and USA UK has 4 fundamental ingredients 1. Nursing research agenda 2. Research funding through National Institute for Health Research Large trials, Programme Grants, Research for Patient Benefit , Fellowships 3. Clinical Research Networks – Research Nurse infrastructure 4. Clinical Trials Units/Methodologists © CTRU 2013
  122. 122. Research areas/pathways- Leeds Risk Factors QOL Living with a PU Pain Living with PU Severe Pu Erythema Imaging Mattress effectiveness OR mattress Case studies Conceptual Framework Outcome Measure Development QOL/Pain systematic reviews Epidemiology Risk Factor Studies Epidemiology Prevalence PUQOL Field Testing Epidemiology Risk Factor PUQOL Instrument Pain assessment and management © CTRU 2013 Systematic review Clinical Practice – NHS investigation Clinical Practice Service Development HTA Pressure HTA PRESSURE 2 Early phase trial design Risk Assessment
  123. 123. Pain and pressure ulcers Living with a pressure ulcer Qualitative study Patients reported pain preceding PU development and said nurses ignored their concerns Living with a pressure ulcer QOL and Pain systematic reviews Pain worst symptom of having a pressure ulcer. Pain impacts upon quality of life and is not addressed by hcps © CTRU 2013
  124. 124. Pain and pressure ulcers Extent of pressure area related pain Prevalence hospital and community populations 3397 hospital patients, 15.9% pressure area pain © CTRU 2013 287 community patients with PUs, 75.6% reported pain Severity not related to PU Category Pain reported on skin sites with no PUs Mix of inflammatory and neuropathic pain
  125. 125. Pain and pressure ulcers Is pain important in predicting Category 2 PU development? Cohort study hospital and community populations 30+ centres, 634 patients analysis population 602 . © CTRU 2013 Variable Presence of category 1 PU(yes vs no) Odds Ratio 3.25 p-value <0.0001 Presence of skin alterations(yes vs no) 1.98 0.0014 Presence of pain on a normal, altered or Category 1.56 1 skin site(yes vs no) 0.0931
  126. 126. Severe PU • • Inquiry style study (Laming Inquiry, 2003) Innovative retrospective case study design to examine whole system failures Results:  Clinicians fail to listen to patients/carers  Clinicians fail to assess risk/respond to superficial PUs  Co-ordination failures  Current practice of investigation does not include patient account and as a result there are gaps © CTRU 2013
  127. 127. Risk Assessment Which of your patients are at risk? Multiple risk factors – which risk factors are most important? Only 0.34% of hospital patient admissions will develop a pressure ulcer. © CTRU 2013
  128. 128. PU Risk Factor Systematic Review Research Question: Which risk factors are independently predictive of PU development in surgical, medical and community-based populations? Result 15 Risk factor Domains 46 Sub-Domains How useful is this for clinical practice? © CTRU 2013 Flow of studies: 5,462 5,097 Abstracts/papers retrieved Excluded – not satisfying eligibility criteria 365 311 Potentially relevant, obtained in full for further scrutiny Excluded – not satisfying inclusion criteria Included 54 Studies 34 Prospective cohort 9 Record Review 11 RCTs
  129. 129. PU Risk Factor Systematic Review Key Risk Factor Themes included:  Immobility  Skin condition  Perfusion (including diabetes) Less consistently emerging themes included: Moisture Body temperature Nutrition Age Gender Mental Status Race Sensory Perception Medication General Health Status Haematological measures © CTRU 2013
  130. 130. Risk Assessment Framework Aim: to agree a pressure ulcer risk factor minimum data set (MDS) to underpin the development & validation of a risk assessment framework (RAF) for use in clinical practice. Phase 1 Development of evidence base Phase 2 Consensus study Phase 3 Design & Pre-Test PU Risk Factor Systematic Review to identify risk factors independently predictive of PU development Agree: - risk factors & assessment items for inclusion in draft risk factor MDS & RAF - Conceptual framework development - RAF Design - Assess & improve acceptability, usabilit y, format, design, cla rity, comprehension language & data completeness of draft RAF with clinical nurses Clinical Pre-Clinical © CTRU 2013 Pre-Clinical Phase 4 Clinical Evaluation - Evaluate reliability, data completeness, clinica l usability, & validity (convergent & known groups) of preliminary RAF Clinical Phase 5 Long-term Implementation & Clinical Evaluation - Dissemination of RAF into routine NHS care - Predictive Validity testing - Multivariable modelling & revision of RAF Clinical
  131. 131. Consensus methods Questionnaires Face to face meetings © CTRU 2013
  132. 132. Risk Factor Progression 15 Risk factor domains & 46 sub-domains of the systematic review reduced to 26 risk factors following initial expert group meeting 1. Immobility 2. Existing PU 3. Previous PU 4. General skin status 5. Chronic wound 6. Friction & shear 7. Sensory Perception 8. Diabetes 9. Pitting oedema 10. Lowering BP 11. Smoking 12. Cardiovascular disease 13. Albumin 14. Haemoglobin 15. Skin moisture 16. Dual incontinence 17. Medication 18. Acute illness 19. Infection 20. Body Temp 21. General health status 22. Nutrition 23. Mental status 24. Race 25. Gender 26. Age Cycle 1: Risk factor premeeting questionnaire 1. Immobility 2. Existing PU 3. Previous PU 4. General skin status 5. Diabetes 6. Nutrition 7. Sensory Perception 8. Dual incontinence 9. Skin Moisture 10. Acute Illness 11. Body Temp 12. Albumin Cycle 1: Risk factor postmeeting questionnaire 1. Immobility 2. Existing PU 3. Previous PU 4. General skin status 5. Perfusion 6. Diabetes 7. Nutrition 8. Sensory Perception 9. Skin Moisture 10. Dual incontinence 11. Albumin Cycle 2: Minor Refinement of Risk Factors (incorporated in pre-meeting questionnaire) 1. Immobility 2. Existing PU 3. Previous PU 4. General skin status 5. Perfusion 6. Diabetes 7. Nutrition 8. Sensory Perception 9. Moisture Risk Factors for Screening & Full Assessment Stage of MDS and RAF Screening Stage Immobility PU Status (existing & previous) Full Assessment Stage Immobility PU Status (existing & previous) General skin status Perfusion Diabetes Sensory perception Moisture Nutrition
  133. 133. Initial draft of the RAF and underpinning MDS © CTRU 2013
  134. 134. Pre-test - Focus Groups © CTRU 2013
  135. 135. Take home messages at your patients skin Ask and listen to patients Problem solve for complex patients
  136. 136. References Pain Briggs M, Collinson M, Wilson L, Rivers C, McGinnis E, Dealey C, Brown JM, Coleman SB, Stubbs N, Stevenson R, Nelson EA, Nixon J (2013) The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients BMC Nursing Vol 12 (1), p19 http://www.biomedcentral.com/1472-6955/12/19 Stevenson R, Collinson M, Henderson V, Wilson L, Dealey C, McGinnis E, et al. The prevalence of pressure ulcers in community settings: An observational study. International Journal of Nursing Studies 2013;DOI: http://dx.doi.org/10.1016/j.ijnurstu.2013.04.001. Gorecki C, Closs J, Nixon J, Briggs M. (2011) Pressure ulcer pain: a mixed method systematic review. Journal of Pain and Symptom Management. Journal of Pain and Symptom Management Vol 42(3):443-59 Risk factors Coleman S, Gorecki C, Nelson EA, Closs J, Defloor T, Halfens R, Farrin A, Brown JM, Schoonhoven L and Nixon J. Patient Risk Factors for Pressure Ulcer Development: Systematic Review International Journal of Nursing Studies Vol 50 (7) p9741003 http://www.sciencedirect.com/science/article/pii/S002074891200421X Nixon, J., Cranny, G. and Bond, S. (2007) Skin alterations of intact skin and risk factors associated with pressure ulcer development in surgical patients. International Journal Nursing Studies Vol 44: 655-663 Nixon, J., Nelson, E. A., Cranny, G., Iglesias, C., Hawkins, K., Cullum, N., et al on behalf of the Pressure Trial Group. (2006) Pressure Trial: Pressure RElieving Support SUrfaces: a Randomised Evaluation. Health Technol Assess Vol 10 (22).
  137. 137. References QOL Gorecki C, Brown JM, Cano S, Lamping DL, Briggs M, Coleman S, Dealey C, McGinnis E, Nelson EA, Stubbs N, Wilson L, Nixon J (2013) Development and validation of a new patient-reported outcome measure for patients with pressure ulcers: The PU-QOL instrument. Health & Quality of Life Outcomes, DOI: 10.1186/1477-7525-11-95 Gorecki C, Lamping D, Alvari Y, Brown J, Nixon J (2013) Patient-reported outcome measures for chronic wounds with particular reference to pressure ulcer research: A systematic review. International Journal of Nursing Studies, DOI: 10.1616/j.ijnurstu.2013.03.004 Gorecki C, Nixon J, Madill A, Firth J, Brown JM (2012) What influences the impact of pressure ulcers on health-related quality of life? A patient-focused exploration of contributory factors. Journal Tissue Viability Vol 21: 3-12 Gorecki C, Closs J, Nixon J, Briggs M. (2011) Pressure ulcer pain: a mixed method systematic review. Journal of Pain and Symptom Management. Journal of Pain and Symptom Management Vol 42(3):443-59 Gorecki C, Lamping DL, Brown J, Madill A, Firth J, Nixon J. (2010) Development of a conceptual framework of health-related quality of life in pressure ulcers: a patient-focused approach. International Journal of Nursing Studies, 47: 1525-1534. Gorecki CA, Brown JM, Briggs M, Nixon J. (2010) Evaluation of five search strategies in retrieving qualitative patient-reported electronic data on the impact of pressure ulcers on quality of life. Journal of Advanced Nursing, 66 (3): 645-652. Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, Defloor T, and Nixon J on behalf of the European Quality of Life Pressure Ulcer Project Group (2009). Impact of pressure ulcers on quality of life in older patients: a systematic review JAGS 57: 1175-1183 Spilsbury K, Petherick E, Cullum N, Nelson EA, Nixon J and Mason S. (2008) The role and potential contribution of clinical research nurses to clinical trials. Journal of Clinical Nursing 17 (4), 549–557.
  138. 138. Acknowledgement PURSUN (Pressure UlceR Service User Network) NIHR: This presentation presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (RP-PG-0407-10056). The views expressed in this presentation are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. © CTRU 2013
  139. 139. Student Competition to be launched Student Rate £35.00 per day
  140. 140. On the couch: an interview Video: Dr Helen Bevan Introduced by Charlotte Johnston Student nurse University of Lincoln
  141. 141. 6 c’s – aims, website and Care Makers Dr Ruth May Chief Nurse NHS England Midlands and East and Care Makers
  142. 142. Compassion in Practice Progress and Developments Presented by Ruth May Regional Chief Nurse NHS England (Midlands & East) October 2013
  143. 143. The Nursing Narrative 156 NHS England | Ruth May | Twitter: RMayNurseDir
  144. 144. The Keogh Review • A limited understanding of and failure to genuinely listen to patients and staff • The lack of value and support being given to frontline clinicians, particularly junior nurses and doctors • More work needed at some trusts on issues such as reducing incidents of pressure ulcers • Essential standards for staffing 157 NHS England | Ruth May | Twitter: RMayNurseDir
  145. 145. Developing the culture of compassionate care 158 NHS England | Ruth May | RMayNurseDir
  146. 146. Our values and behaviours are at the heart of the vision and all we do Care Compassion Competence Communication Courage Commitment 159 NHS England | Ruth May | Tw itter:RMayNurseDir
  147. 147. Six Areas for Action Helping people to stay independent, maximising well-being and improving health outcomes Working with people to provide a positive experience of care Delivering high quality care and measuring impact Building and strengthening leadership Ensuring we have the right staff, with the right skills in the right place Supporting positive staff experience 160 NHS England | Ruth May | RMayNurseDir
  148. 148. The children’s community nursing team at Cambridgeshire Community Services NHS Trust has been announced as the winner of NHS England’s 6C’s Live! September Story of the Month 161 NHS England | Ruth May | RMayNurseDir Catherine Ray, a senior sister at Solihull Hospital, has been picked as the first ever winner of NHS England’s 6C’s Live! And Nursing Times’ story of the month competition
  149. 149. 162 NHS England | Ruth May | Twitter: RMayNurseDir
  150. 150. What are Care Makers? • We are looking for individuals who can be ambassadors for compassion in practice and who can demonstrate and advocate the 6C’s in their practice • Care makers are ambassadors for the 6C’s • The first cohort of 55 Care Makers were recruited prior to the CNO Conference in 2012 of newly qualified nurses, student nurses, midwives, and healthcare assistants • Principles for creating this network include To inspire young people A shared purpose to transform the NHS Culture in Nursing, midwifery and care staff To be advocates for compassion in practice 163 NHS England | Ruth May | RMayNurseDir
  151. 151. How to become a Care Maker • From mid-October applications can be downloaded from http://www.nhsemployers.org/caremakers/Pages/How-do-I-become-a-caremaker.aspx • Applications should be submitted, including a reference from an appropriate senior representative, to caremakers@nhsemployers.org • NHS Employers sift through applications into yes – queries to go to Region • On a set day every month NHS Employers will send applications to regional nurses for review with partner organisations if agreed • Applications will be assessed against the definitions of the 6C’s • We need to recruit 350 in the next round; the national target is 1000 by the end of March 2014 164 NHS England | Ruth May | Twit ter:RMayNurseDir
  152. 152. Tweets and Pledges: how have we done? Lynnette Leman Digital Communications Officer NHS Improving Quality Joe McCrea Film maker and Strategic Adviser NHS Change Day
  153. 153. Wrap up, thanks, reflections on the day and looking to the future Professor Sara Owen and Charlotte Johnston University of Lincoln Dr Ruth May and Lyn McIntyre NHS England Midlands and East

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