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
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
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. 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.
16.
17.
18. 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.
19. 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.
20. 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 .
21. Can you measure Pressure?..
‘a perpendicular load or force exerted on a
unit of area’
Bennett and Lee (1985)
Force
Pressure = --------------Surface Area
24. Variables - ‘evidence based’
• Age
• Nutrition
• Medical Condition
• Medical Interventions
• Peripheral Vascular
Disease (PVD)
• Patient Support
Surfaces
• Drug Therapy
• Care being Given
25. 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.
26. 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?
27. 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.
28.
29. 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
30. Medication
• Anti-inflammatory drugs (including aspirin)
and steroids may prevent healing.
• Chemotherapy drugs may damage healthy
tissues.
• Sedative drugs may affect mobility and
sensation.
31. 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
32. Sensory Impairment/
Reduced Consciousness
• Unaware of the need to relieve pressure.
• Consider
–
–
–
–
–
Unconsciousness
Sedation
Spinal Cord Injury
Diabetic neuropathy
Neurological Conditions egg MS, CVA
33. 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.
34. Incontinence
• Urinary and faecal incontinence cause
excoriation of the skin.
• Moisture causes maceration of the skin.
• Consider
– Barrier creams/films
35. Skin Hygiene
• Excessive use of soaps will remove the
skin’s natural protective oils and dehydrate
it.
• Consider
– Skin cleansers
36.
37.
38. 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)
46. 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
47. 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)
48. 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
49. Prevention and Management
• Use of appropriate patient support surfaces
• Skin assessment and good hygiene
• Evidence based moving and handling
practice
• Nutrition
• Hydration
• Incontinence
52. 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.
53.
54. 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.
55.
56. 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
57.
58. 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
62. 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
64. 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
65. 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
66. 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
67. 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
71. SSKIN mini quiz
Mark Collier
Tissue Viability Nurse
Consultant
United Lincoln Hospitals
NHS Trust
72. 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
73. Question 1
What does the second S of SSKIN
stand for?
• Surface (green)
• Skin Inspection (red)
74. Question 2
What is the prime function of an
alternating pressure mattress (APM),
such as a Nimbus III?
• Pressure reduction (green)
• Pressure relief (red)
75. 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)
76. Question 4
How would you categorise?
• Pressure ulcer (green)
• Moisture lesion (red)
78. 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
79. Question 6
Who is responsible for the
application of the principles that
underpin SSKIN in clinical settings?
• Everybody (green)
• All healthcare professionals (red)
81. Impact of good
nutrition and hydration
on pressure ulcer
prevention and care
Dr Ailsa Brotherton
Director for Clinical
Engagement and Leadership
NHS QUEST PMO
83. 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
84. 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
85. 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
86. 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
88. 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
89. 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.
90. 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
91. 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
93. 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
94. 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
95. 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‟
96. 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
97. 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
99. 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
100. 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
101. Student nurse
design for SSKIN
Charlotte Johnston
and student nurse
colleagues
University of Lincoln
103. 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
104. 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
105. 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
106. 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
107. 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
108. Change agents and
boat rockers
Video: Dr Helen Bevan
Introduced by
Lyn McIntyre
Deputy Nurse
Director, Midlands and
113. Unique individuals that received a
#stopthepressurelincoln tweet … 214,130
Total number of timeline deliveries… 1,610,570
Total number of tweets… 1,420
114. Stop the pressure
and nutrition:
interactive session
Lyn McIntyre
Deputy Nurse Director
Midlands and East
Andy Yeoman
Focus Active Learning
116. 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
117. The Nutrition Game
• 1 board
• 1 set of question
cards (face down)
• 2 counters
• 2 dice
• 1 sand timer
• 1 “Pee chart”
118. 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
119. Answer questions
• Team answers
question (use timer)
• Correct answer
MOVE forward 2
squares
• Opposite team roll
dice and move
• Repeat as before
120. 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
123. 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
124. Stop the Pressure Game
• Team answers
question (use timer)
• Correct answer
MOVE 2 squares
• Opposing team roll
dice and move
• Repeat as before
125. Stop the Pressure Game
• Team LAND on an
SSKIN square
• Opposite TEAM picks
up a SSKIN question
card and reads out
the question
126. Stop the Pressure Game
• Correctly answer
WIN an SSKIN token
• TEAM places SSKIN
token on board
127. Stop the Pressure Game
• Correctly answer
WIN an SSKIN token
• TEAM places SSKIN
token on board
• Place SSKIN token on
board
128. 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
131. Making a difference
through practice led
pressure ulcer
research
Professor Jane Nixon
Deputy Director
Institute of Clinical Trials
Research
University of Leeds
148. Take home messages
at your patients skin
Ask and listen to patients
Problem solve for complex patients
149. 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).
150. 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.
157. 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
159. 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
160. 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
161. 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
163. 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
164. 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
165. 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
166. 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
Editor's Notes
Self explanatory – may be worth pointing out that if we were to redo the health economics analysis on 2011 figures we would expect much higher costs
They set a clear aim and exceeded their target for rescreening using ‘MUST’
Sal
BethNeed to be able to pass on our knowledge to our patients and explain ways to prevent damage either in an acute setting or when they are discharged.
Mel
Charlie
Siobhan + Ashleigh
Over the last couple of years the NHS has not only seen tremendous change, but has had to answer for the quality of care and culture within its organisations.These difficulties have been highlighted within the Francis report and most recently Don Berwick’s review of the NHS safety culture.Nursing care has never before been under the spotlight in such a way. We have heard some terrible stories relating to poor care from distressed relatives to other members of the nursing teams.
The Keogh Reviews have once again highlighted the need for a National robust nursing & midwifery strategy which of course as you know is compassion in practice
CNO Jane Cummings launched the nursing & midwifery 3 year strategy at last years CNO conference. The National lead is Juliet Beal and our Regional lead is Julie Firth.With the findings of the Keogh Reviews, and the Don Berwick review on the NHS, Compassion in Care has become even more relative in these changing times.
So let’s remind ourselves……CareDelivering high quality care is what we do. People receiving care expect it to be right for them consistently throughout every stage of their life.CompassionCompassion is how care is given, through relationships based on empathy, kindness, respect and dignity.CompetenceCompetence means we have the knowledge and skills to do the job and the capability to deliver the highest standards of care based on research and evidence. CommunicationGood communication involves better listening and shared decision making - ‘no decision about me without me’.CourageCourage enables us to do the right thing for the people we care for, be bold when we have good ideas, and to speak up when things are wrong. CommitmentCommitment will make our vision for the person receiving care, our professions and our teams happen. We commit to take action to achieve this.
Notes from left to rightDeliver evidence-based care & extend evidence through researchExplicitly demonstrate our impact on outcomes Make ‘every contact count’ to promote health and wellbeingSupport people to remain independentMaximise the contribution to specialist community public health nursingDesign our services so people, and their carers and family are active participants in their carePrioritise patients and the people who receive care in every decision we makeCollect, listen to and act on feedback and complaintsPromote personal responsibility for health and wellbeingFollow evidence-based best practice to deliver high quality outcomes to those that use health and care services Measure what we do and our contribution to qualityBe transparent and publish the outcomesPromote careers in research to strengthen the focus on evidence based practiceEnsure all registered nurses & midwives understand their leadership role with the wider care-giving teamFree our leaders to have time to lead e.g. supervisory status, better use of technologyEmpower nurses, midwives & registered managers to make local changes to improve care.Use evidence based staffing levelsCommit to and support life long learning for the whole care-giving teamRecruit staff with the right culture & valuesCreate worthwhile & rewarding jobsCreate equality of opportunitySupport each other & new entrants to the professionsBe professionally accountableEmbrace new technologyBe productive and efficient
Cambridgeshire children’s community nursing team provide life-lineThe children’s community nursing team at Cambridgeshire Community Services NHS Trust has been announced as the winner of NHS England’s 6Cs Live! September Story of the Month.Team photo, from left to right: Jenni Sherman, Children’s Community Nurse; Vicky Amiss-Smith, Continuing Care Nurse; MagsHirst, Play SpecialistThey have been chosen for the care they give to eight year old Ollie Duell and his family from Cambridge, helping them cope with the devastating impact of his illnesses. Ollie’s mum Claire explains: "Since he was a baby Ollie has lived with a condition called Intestinal pseudo-obstruction where the intestines lose their ability to contract and push food and stools through his system." "Ultimately," she continues "this resulted in Ollie needing a multi-organ transplant (bowel, stomach, intestines and pancreas) and creation of a stoma at the Birmingham Children’s Hospital in October 2010 when he was just five years old. Since then he has had multiple problems with his stomach, bowel, intestines, duodenum and colon. "The nurses from the children’s community nursing team have been with us since Ollie was 3 months old, so know him inside out and provide the majority of his care at home, hugely reducing the amount of time he has had to spend in hospital."She says that the children’s nursing team have offered them a life-line, becoming part of their family and continues:"I cannot thank the children’s nursing team enough for all the care they give Ollie and the entire family. We consider them an integral part of our family life; without them it’s simple, we just wouldn’t cope."Ollie, like most boys is addicted to computer games and, as MagsHirst, Play Specialist with the children’s community nursing team explains, this can be used as a positive part of this care programme: "Ollie is a very special boy and copes with his conditions remarkably well but like all of us, every now and then he needs that extra bit of help. Through therapeutic play, we use computer games as one way to help him manage any concerns or fears he may have about his illness and treatment."The panel - which includes representatives from NHS England, Nursing Times, a 6Cs Live! patient champion and the RCNs Nurse of the Year – felt that the children’s community nursing team exemplified the values of the 6Cs. Sam Sherrington, Head of Nursing and Midwifery Strategy at NHS England, said:"When we read Ollie’s story it really struck all of the panel members how much of a difference the children’s community nursing team make to his and his family’s life. The team’s work shows that where the 6Cs of care, compassion, courage, commitment, communication and competence are used it is really felt by the patient and their families""The team not only provide vital care to Ollie but enable his family to spend precious time re-charging their batteries and doing the everyday simple things that most of us take for granted."As a result of the team’s fantastic care Ollie has been able to spend much more time at home and avoid stays in hospital as much as possible."Catherine Ray, a senior sister at Solihull Hospital, has been picked as the first ever winner of NHS England’s 6Cs Live! and Nursing Times’ story of the month competition.Catherine’s story was chosen from nearly forty other entries by the judging panel, which includes representatives from NHS England, Nursing Times, a 6Cs Live! patient champion and the RCNs Nurse of the Year.It was chosen because Catherine’s work showed exceptional nursing practice and embodied the 6Cs, showing care, compassion, competence, communication, courage and commitment towards her patient and his family.Catherine described how a patient with terminal lung cancer was made to feel as comfortable as possible and ensured his family was around him, with her going as far as to arrange for the gentleman’s pregnant daughter to have a 4D scan so he could see images of his unborn grandson.Catherine said:“The atmosphere on the ward was indescribable and the patient was so excited to meet his grandson, his spirits lifted and the staff were so happy to be a part of it.The patient went home soon after and died peacefully with his family around him.Catherine continued:“The family have been back on the ward a few times to visit and the last time they brought the new addition to the family, the healthy baby boy that we saw on that scan.”Sam Sherrington, Head of Nursing and Midwifery Strategy at NHS England, said:“Catherine went above and beyond to make her patient’s last few weeks as comfortable as possible, arranging a side room with an additional bed for his family to stay with him, arranging for him to go home the same day he decided – and the 4D scan showed such compassion.“It’s these individual stories that we want to hear about. There’s so much great nursing care going on right across the country and this is our chance to really shout about it.”Mandie Sunderland, chief nurse at Heart of England NHS Foundation Trust, said:“Good nursing requires many skills and attributes which have a positive impact on the patient experience and these are illustrated wonderfully in this short story.“Examples of where nurses have gone the extra mile to provide care and compassion like this should be celebrated. I am proud of Catherine’s achievement as winner of the first story of the month competition.”NHS England, in partnership with Nursing Times, is running the story of the month competition to find good examples of 6Cs practice and the winning story will be featured on the Nursing Times website and the 6Cs Live! Communications Hub.