The Zero Tolerance approach to patients acquiring pressure ulcers within
Health Board hospitals ABM University
ABM University Health Board has been working to stop patients getting pressure sores in our hospitals for the past three years. The Health Board has based its work on an approach that had been used successfully in America called the SKIN Care Bundle.
(A care ‘bundle’ is a series of evidence-based good practice actions which must be followed, and if a step is left out, it has to be because there is a sound clinical reason for it to be left out.)
SKIN Standards for the main elements of care required to prevent pressure damage:
Surface- ensuring patient has the right mattress and chair cushion for them and this is regularly reviewed
Keep Moving- a plan of how frequently patients should be moved is to be put in place to prevent long periods of time with continual pressure on skin- patients are either encouraged to move independently or supported or moved by the nurses depending on their needs
Incontinence- ensuring that patients continence needs are met on a regular basis to prevent skin getting moist
Nutrition – ensuring that patients receive the required nutritional support to keep the skin healthy
All patients should be assessed for the risk of them developing skin damage through pressure and requiring nutritional support. All patients assessed as being at risk of developing skin damage are placed on the SKIN bundle. Implementing this bundle in partnership with patients and their family is essential. This requires full discussion and involvement in all elements.
The initial aim was to reduce the incidence of patients developing pressure ulcers in hospital by 50% on the pilot ward (Anglesey Ward at Morriston Hospital). Within a year the incidence reduced from 4% to zero. In over three years that ward has had just one minor incident.
Picture: The initial scheme was piloted by the staff on Anglesey Ward at Morriston Hospital.
SKIN bundles have been since put in place across 92 wards in ABM’s hospitals as well as the A&E departments, critical care areas and patient assessment areas (MAU, CDU etc). This has resulted in the number of patients developing pressure ulcers in our hospitals reducing from 10% to 1%. A full investigation is undertaken following each incidence and the Health Board is aiming towards no patients developing pressure sores in our hospitals.
This work is now being tried within nursing homes and on patients within the community.
Every ward measures how they are doing in relation to this work every month. We look at:
- % compliance with SKIN bundle
- % compliance with nutritional risk assessment
- % compliance with pressure ulcer risk assessment
- Numbers of pressure ulcer incidents
The main effect of this change if it was to be described in one sentence it would be that: the work has resulted in an organisational cultural shift from a belief of many that pressure ulcers was an inevitable outcome for some hospitalised patients to a belief that in the main pressure ulcers are preventable.
ABM records all skin damage as an incidence and this include areas that have become very red with no broken skin. A high percentage of wards across ABM have gone > 500 days without an incident of a pressure ulcer and some have gone > 600 days. These include community hospitals, surgical, and medical wards.
The initial pilot Anglesey Ward has only had 1 grade 2 (minor damage) pressure sore develop since they started the work. The ward went 638 days with no skin damage a patient developed minor damage in January 2010. A full investigation was undertaken, the cause was identified and addressed and there have been no incidences since.
ABM as shared this work widely. The care bundle has been rolled out across all Health Board’s in
through the 1,000 lives plus programme. The Health board has also shared this work with Scottish, English and Danish Health Organisations. Wales
ABM's innovative zero tolerance pressure ulcer scheme has picked up a number of awards including:
- Patient Safety in Clinical Practice - the Health Service Journal/Nursing Times Patient Safety Awards 2010.
- Improving Quality through Better Use of Resources Award – NHS Wales Awards 2009 ‘Pressure Ulcer Prevention – Zero Tolerance’, ABM University NHS Trust
- Molnlycke Health Care Wound Academy team scholarship 2009
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