The document discusses the impact of a clinical nurse specialist (CNS) in tissue viability on reducing pressure ulcers in older adult care settings. It finds that since introducing the CNS role, there has been a marked reduction in pressure ulcer prevalence from 4.6% to 2.3%, incidence from 18% to 6.6%, and grade 4 ulcers from 5.6% to 0.3%. The CNS role focuses on education, motivation, monitoring prevalence and incidence, collaboration, risk assessment, empowering staff, and has led to improved patient outcomes in pressure ulcer prevention.

1. The impact of a CNS in tissue viability on
the reduction of pressure ulcers in care
of the older person setting
Maree Barry
RGN, HdipTissue Viability,
PG:PEPPD, RNP
St Mary’s Hospital
Phoenix Park
EPUAP & NUAP 2009

2. Pressure Ulcers
EPUAP & NUAP 2009
Pressure Ulcers cause great pain and
suffering
Gorecki et al (2009), Hopkins et al (2006)
The incidence and severity of
preventable pressure ulcers is a
key indicator of quality of care
Benbow and Bateman (2012)

3. Pressure Ulcers
EPUAP & NUAP 2009
Mean pressure ulcer prevalence rates
in Ireland
16% (4 - 37%) n = 6
Mean pressure ulcer incidence rates
in Ireland
11% (8 – 14%) n = 4
Moore et al (2013)

4. The Role of CNS in Tissue
Viability
EPUAP & NUAP 2009
The CNS in tissue viability plays a
key role in the prevention of
pressure ulcers
Guy et al (2010)
It is well documented that the CNS
improves patient outcomes and
quality of care
Very little evidence to support this
Doody and Bailey (2011)

5. Study Aim </p>
EPUAP & NUAP 2009
Explore the impact of CNS in
tissue viability in the reduction of
pressure ulcers in care of the older
adult setting

6. Methods
EPUAP & NUAP 2009
Incidence, prevalence and healing rates
monitored since 2007
Data collected by purposeful sampling
through direct referral to TVN
Retrospective

7. The TVN EMPOWER Model
EPUAP & NUAP 2009
E – Education
M – Motivate
P - Prevalence, incidence and healing
O - Other professionals
W – Who
E – Enable
R - Results

8. Education
EPUAP & NUAP 2009
•Link Nurses/Healthcare assistants
•Ward based education for all
staff members
•Formal education for multidisciplinary team
•Student nurses
•Medical students
•Residents and families
•Opportunistic teaching sessions
•Documentation
•Reporting

9. Motivation
EPUAP & NUAP 2009
•Work closely with frontline staff
•Communication
•Passion
•Enthusiasm
•Support
•Trust and respect
•Role Model
•Identify positive outcomes
•No Blame
•Encourage

10. Prevalence
EPUAP & NUAP 2009
Prevalence
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
2007
2008
2009
2010
2011
2012
2013
%

11. Incidence
EPUAP & NUAP 2009
Incidence
35
30
25
20
15
10
5
0
2007
2008
2009
2010
2011
2012
2013
%

12. Severity
EPUAP & NUAP 2009
Grade 4
12
10
8
6
4
2
0
2007
2008
2009
2010
2011
2012
2013
%

13. Other Professionals
EPUAP & NUAP 2009
•The input from the multidisciplinary team
is essential in pressure ulcer prevention
•Co-ordinated team planning,
implementation and evaluation is
necessary to ensure the patient receives
holistic high standard quality care
•Improved communication between
disciplines improves patient outcomes
•Gain respect and insight into each
disciplines knowledge and skills

14. Who
EPUAP & NUAP 2009
•Skin Assessment
•Risk Assessment
•Mobility
•Nutrition
•Incontinence
•Age
•Tissue tolerance
•Manual Handling
•When risk identified appropriate
interventions implemented
•Documentation

15. Enable
EPUAP & NUAP 2009
•Skills and knowledge
•Enabling not disabling/de-skilling
•Competence
•Confidence
•On-going education
•On-going support
•Encouragement
•Communication
•Availability of resources
•Empower

16. Results
EPUAP & NUAP 2009
•Overall reduction in the prevalence
of pressure ulcers from 4.6% to 2.3%
•Overall reduction in the incidence of
hospital acquired pressure ulcers
18% to 6.6%
•Overall reduction in grade 4
pressure ulcers from 5.6% to 0.3%
•Average age of population 80

17. Conclusion
EPUAP & NUAP 2009
Since the introduction of the CNS in
tissue viability there has been a marked
reduction in prevalence and incidence
of pressure ulcers demonstrating the
positive impact of this role on patient care.
The study also identified a significant
decrease in the number and severity
of hospital acquired pressure ulcers

18. Pressure Ulcer Collaborative
EPUAP & NUAP 2009
Pressure Ulcer to Zero is a National Quality Improvement
Programme
22 Pilot sites in Meath, Louth, Cavan, Monaghan and North
Dublin, across many settings, acute hospitals, primary care
Centres, nursing homes and other community and private
Residential settings
Aim is to reduce the incidence of avoidable pressure ulcers
initially by 50% and ultimate goal is 0%

19. Thank You
EPUAP & NUAP 2009

20. References
EPUAP & NUAP 2009
Benbow,M., Bateman,S 2012 Working towards clinical excellence -
Pressure ulcer prevention and management in primary and
Secondary care. Journal of Wound Care 21:(9): S25-S39
Doody.O, Bailey.M, 2011 The development of clinical nurse
specialist roles in Ireland. British Journal of Nursing 20:(14)
868 – 872
EPUAP/NUAP 2009, www.epuap.org
Gorecki,C., Brown,J.M., Nelson,E.A., Briggs,M.,Schoonhoven,L.,
Dealey,C., Defloor,T., Nixon,J 2009 Impact of pressure ulcers on
quality of life on older patients: a systemic review. Journal of the
American Geriatrics Society,57: 1175-83
Guy,H,. Downie.F,. McIntyre.L, 2013 Pressure ulcer prevention:
making a difference across a health authority? British Journal of
Nursing (Tissue Viability Supplement) 22: (12),S4 – S13
Hopkins.A,. Dealey.C,. Bale,S,. Defloor. T,. Worboys.F,2006
Patient stories of living witha pressure ulcer.
Journal of Advanced Nursing 56: 345-353
Moore,Z,. Johanssen.,E, Van Mitten,M. 2013 A review of PU
Prevalence and incidence across Scandinavia, Iceland and
Ireland (Part 1), Jornal of Wound Care, 22: (7), 361 - 368