This newsletter from Advanced Clinical Training Services provides information on pressure ulcer prevention. It discusses why pressure ulcer prevention is important, key statistics on pressure ulcers in the UK, and the ASSKING assessment tool for evaluating risk factors. It also advertises the company's pressure area care training course and clinical audit services to help healthcare organizations improve tissue viability practices and compliance.

1. &
Advanced Clinical Training Services
Pressure Area Care
www.advancedclinicalsolution.co.uk

2. Welcome to our latest issue
of Hints &Tips!
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Contents
01 Pressure Ulcer Prevention
info@advancedclinicalsolution.co.uk
Why is it important ?
02 ASKKING Assessment
Pressure Area Care Training & Audit
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3. Issue 04 4
Foreword
Welcometo our latestissue of Hints & Tips, your regularnewsletter full of updates
and information.
Ifthereareanytopics,you’dlikeustocoverinfutureissuespleaseletus know
at info@advancedclinicalsolution.co.uk
5
Pressure Ulcer Update
The occurrence of pressure ulcers is an
indicator of care quality. In recent years, there
has been considerable effort to reduce the
number of pressure ulcers and related harm,
but this effort has been offset by disparities
between in the way they define, measure and
report pressure ulcers. New guidance on
pressure ulcer definition and measurement in
England has been issued by NHS
Improvement .The guidance will be rolled out
nationally from April 2019. This hints & tips
discusses the guidance in more detail.
Pressure Ulcer Prevention
and why is it important ?
Preventing pressure ulcers has become more
important than ever now that they are deemed
to be a marker of good, or poor, care.
Why is it important?
Healthcare professionals have a key role to play in:
- The prevention of pressure ulcers
- The education of those being cared for
- The education of others involved in the
care
Key Statistics
DID YOU KNOW THAT PRESSURE ULCERS
AFFECT AROUND 20% OF PEOPLE IN NURSING AND
RESIDENTIAL HOMES?
24,674 patients were reported to have developed a new
pressure ulcer in one year-That is approximately 1300 per
month
The cost of treatment per patient is approximately £1,214
per Grade 1 and £14,108 per Grade 4 (Dealey et al 2012).
Patients with a diagnosis of Dementia/Alzheimer's and
Cancer are at highest risk.
First page 2 3 4 5 6 7 8 9 10 11 12

4. Issue 04 6 7
ASSKING assessment tool ASSKING ASSESMENT
NHS Improvement have launched their latest
public health campaign aimed to increase
healthcare professional and public awareness about
the damaging impact of pressure ulcers
.
ASSKING is a model of assessment for skin,
prevention of pressure ulcers and when
necessary, their management:
A-Assessment of Risk
Within 6 hours of admission to Care Home (NICE
Quality Standard QS89 2015)
After a surgical or interventional procedure or
following a transfer. (NICE Quality Standard QS89
2015)
Consider using a validated scale to support clinical
judgement (for example, the Braden scale, the
Waterlow score or the Norton risk-assessment
scale) when assessing pressure ulcer risk. (NICE
Guideline CQ179 2014)
Reassessment should be carried out if there is any
significant change in the patient’s/client’s condition.
S-Skin Inspection & Care
WHEN Within 8 hours of admission
to hospital or care home
As part of every risk assessment Within
24 hours of admission to any care
setting
Or on the first visit from the community
services or teams, for example,
community nurse, hospital at home,
social care or care at home
Reassessment should be based on
individual risk and increased if condition
deteriorates (NPUAP, 2014)
WHERE Conduct a head-to-toe
assessment with particular focus on skin
overlying bony prominences including the:
Sacrum
Ischial Tuberosities
Greater trochanters
Heels
S-Support Surface
Two Types:
Pressure reducing Static overlays (mattress and
cushion) Cut Foam, memory foam distributes
the patient’s weight more evenly across the
surface of the mattress
Pressure relieving Air alternating overlays and
mattresses designed to completely remove the
pressure from areas of the patient’s skin.
K-KEEP MOVING
Repositioning is an essential element for
someone at risk of developing a pressure
ulcer
Time period between repositioning is
dependent on the patient’s/client’s risk
status. Consider:
tissue tolerance,
level of activity and mobility,
general medical condition,
overall treatment objectives,
skin condition, and
comfort
If risk assessments show they are at high
risk, start a repositioning chart In addition to
pressure, shear and friction forces may also
put a patient/client at increased risk. The 30º
tilt is a method of positioning the
patient/client to decrease the risk of damage.
What are your barriers to Pressure Area Care ?
No time
Staff shortages
Lack of knowledge
Not sure how to action any outcomes ? Tell us what you think
Our aim for is to help you deliver better outcomes for your patients, so it is important that we
work well for you. Please let us know about your experiences of using external consultancies as
wellasanysuggestionasthiswillhelpustodriveimprovement. Pleaseforward your feedback to:
info@advancedclincalsolution.co.uk

5. Issue 04 8 9
ASSKING CONTINUED…
I-Incontinence & Moisture Care
Cleaning the skin
Gentle soap and warm water is adequate for
normal daily hygiene.
Soap and water should not be used if the
patient/client has moisture damage of the skin in
the groin and/or buttock area.
A pH-balanced skin cleanser should always be
used to clean the skin after an episode of
incontinence.
Use individualised canisters of pH-balanced skin
cleanser for each patient/client.
Barrier creams or barrier films should be used to
prevent further damage to areas of excoriation
Barrier creams should be used on unbroken skin
and films on broken skin.
Treatment with a non-perfumed moisturiser at least
twice a day will help reduce dryness.
Do not massage or vigorously rub skin that is at
risk of pressure ulcers.
N-Nutrition & Hydration
Nutrition and hydration play a key role in keeping
the skin healthy So, think EAT –
Evidence, assessment, take action – when
assessing an individual’s risk of developing a
pressure ulcer (and the healing of existing
pressure ulcers or wounds).
G-Giving Information
Ensure all pertinent information regarding
Pressure Area status is passed on for each
handover to all staff
Listen closely to any reports from colleagues or
members of the wider MDT
Inform GP/Next of kin/Resident of any
deterioration in skin condition
Individualised, person centred care plans to
include all assessments
Inform Tissue viability if any Grade 3 or 4 ulcers or
non-healing wounds
Report any grade 3 or 4 ulcer, or multiple grade 2
ulcers, to safeguarding team
This is just a very small insight into good
assessment for pressure area care. A
number of organisations provide useful
guidance materials and tools.
Waterlow Score
Designed by Judy Waterlow MBE in 1985, Her
pressure ulcer risk assessment tool was
originally designed for use by her students.
Currently it is a widely used tool to asses a
person’s risk of pressure ulcers.
Download her score card here.
NICE Guidelines CG179 Pressure Ulcer Prevention
and Management
This guideline covers risk assessment,
prevention and treatment in children, young
people and adults at risk of, or who have, a
pressure ulcer (also known as a bedsore or
pressure sore). It aims to reduce the number
of pressure ulcers in people admitted to
secondary or tertiary care or receiving NHS
care in other settings, such as primary and
community care and emergency departments.
The NICE guidelines can be found here
.
NHS Stop The Pressure
The ‘Stop the Pressure’ campaign was
originally launched by NHS Midlands and East
as part of their ambition to make life better for
patients. The campaign is now managed by
NHS Improvement and aims to increase
awareness about the damaging impact of
pressure ulcers. The symbol is a simple red dot,
designed to bring awareness to the impact of
pressure ulcers. They have developed a toolkit
to support the campaign. Links below
ASSKING TOOLKIT
Pressure Relieving Surface Selection Guide
Useful Further Reading
Braden Risk Assessment Tool
This is a clinical tool you can use to assess risk
of a patient developing a pressure ulcer. Use this
together with your clinical judgement. The
primary aim of this tool is to identify
patients/clients who are at risk, as well as
determining the degree of risk of developing a
pressure ulcer.
The Braden Scale is a scale made up of six
subscales, which measure elements of risk that
contribute to either higher intensity and duration
of pressure, or lower tissue tolerance for
pressure. Further info can be found here.
Useful Information & Links !

6. Issue 04 8 9
Pressure Area Care Training
Many healthcare professionals have never
received formal training in clinical audit or
other quality improvement techniques:
Our Pressure Area Care and Tissue Viability
course is aimed at carers and RGN’s who need
to update their skills and knowledge in the
subject of pressure area care and tissue
viability ,which includes aspects of skin and soft
tissue wounds.
Our course considers preventative measures
for pressure area wound development, the
types of pressure area wounds and current
best practise guidelines and national
campaigns. The learning objectives can be
seen over the page
Our one-day Pressure Area Care Training is
only £499 + VAT for up to 12 learners
delivered on-site in your location. Contact Us
to book
KEY LEARNING OBJECTIVES
✓ Describe the anatomy and physiology of
the skin
✓ Understand the definition and grading of
pressure ulcers
✓ Identify those at higher risk of developing
pressure ulcers
✓ Describe common sites for pressure ulcers
to develop
✓ Explain the materials, equipment and
resources available to prevent and relieve
pressure
✓ Understand the risk factor for pressure
ulcers
✓ Differentiate between pressure, shear and
friction forces.
✓ Outline the role nutritional plays in the
treatment and prevention of skin damage
✓ Examine the latest ways of cleaning skin to
avoid damage
✓ Describe the factors delaying the healing
process
Outside of the NHS, private and smaller
healthcare providers such as nursing
homes, domiciliary care and private
practitioners may be going unsupported in
relation to pressure area care quality
improvement.
Generally speaking, most healthcare
professionals do not receive any specific
training on quality improvement techniques but
are expected to contribute to clinical audit and
compliance efforts.
Advanced Clinical Solutions are now able to
offer both on-site audits of Tissue Viability
Practices and Procedures , and Remote
Licencing of our tools so you can self-audit
your organisation. Prices start from £799.99
for an onsite visit.
On-site audits involve a visit for one of our
team of nurses who will review practices and
supply you with a report and action plan for
improvement (if needed).Many organisations
use this report to evidence quality
improvement in CQC inspections.
Advanced Clinical Solutions has developed
many bespoke and generic clinical audit tools.
All of our tools are aligned to an up to date
evidence base, as well as healthcare regulatory
standards such as the CQC key lines of enquiry
Our current tool for Tissue Viability is a 30 point
review of all aspects of Tissue Viability
,Pressure Area Care and Pressure Ulcer
Management.
To request information on our onsite audits or
to buy a licence to our audit tools please
contact us by clicking here.
No time to audit…… then let us
do the hard work for you !

7. Your dedicated
support line
For further information please contact the team:
info@advancedclinicalsolution.co.uk
01633 415 427
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