STOP Pressure Ulcers is a world-wide day held every November to highlight the prevention and treatment of pressure ulcers. This year, it takes place on 21 November 2019 and Cheryl Crocker has been taking a look at some of the ways AHSNs are helping tackle this important patient safety issue in care homes.
Pressure ulcers often start as unpleasant, uncomfortable injuries to the skin and underlying tissue, usually caused by prolonged pressure from being confined to bed or sitting in a chair or wheelchair for long periods of time. It’s estimated that 1,300 new ulcers are reported a month, and that treating pressure damage costs the NHS more than £1.4 million every day (nhs.stopthepressure.co.uk).
Many pressure ulcers are avoidable with a basic understanding of the causes and by following best practice guidelines. It’s no surprise then that Academic Health Science Networks (AHSNs) and the Patient Safety Collaboratives (PSCs) they host have been tackling this issue with their local trusts and increasingly with care homes.
Anyone can suffer from pressure sores, but the over-70s are at a considerably greater risk so it is even more important in a care home setting that the risks are managed for residents who are less able to move and change position themselves.
There are some excellent examples of good practice in our recent report on AHSNs’ work in care homes. Often they form part of a wider programme of quality improvement interventions, including reducing falls, and improving hydration and nutrition. Here are some examples.
LPZ is a Dutch benchmarking tool, which is being used in the East Midlands for measuring, recording, analysing and sharing the prevalence of six common care problems in care homes, including pressure ulcers. By using a common approach to benchmarking care quality, East Midlands AHSN and PSC have been able to help care homes improve their capacity and capability to recognise, prevent and manage these care problems. For pressure ulcers, they recorded a drop in prevalence from 8.4% of residents to 7%. The health economic evaluation modelled in international work estimated a predicted saving of £4.5 million over three years in just 500 care homes.
Significant 7 is an early warning tool and associated training designed specifically for care home staff. Research showed that most training was too academically focused and was not providing carers with the practical training that they needed, so this package was designed to be simple and fun. UCLPartners is now working in partnership with North East London NHS Foundation Trust (NELFT) and Healthy London Partnership to roll out Significant 7 in care homes across Outer East London. Early results have been very encouraging, with a reduction in pressure ulcers of 23% and reports of increased confidence in staff who use the tool daily.
Safer Provision and Caring Excellence (SPACE)
SPACE was a large-scale care home improvement programme being undertaken in the West Midlands, which aimed to strengthen safety culture and reduce the incidence of adverse safety events. With input from the West Midlands AHSN and PSC, the programme helped up-skill care home staff in quality improvement techniques and facilitated care homes to put changes into practice. Over 1,000 staff received training and an independent evaluation has shown the number of adverse incidents fell, including a drop in Grade 4 pressure ulcers (the most serious) from 0.31 to 0.16 per hundred beds: almost half. SPACE also won this year’s ‘Idea of the Year’ award from ideasUK.
With around 410,000 people living in one of more than 11,000 care homes in the UK, we have only scratched the surface of what’s possible. It is clear that the opportunities to improve people’s quality of life and reduce the financial burden of a range of common care problems to the NHS is immense.
We are supporting the ambition of NHS Patient Safety Strategy to develop a National Safety Improvement Programme for care homes, which we believe has enormous potential to improve safety in this growing sector. The AHSN Network is also developing and delivering a National Wound Care Strategy Programme for England, which has pressure ulcers as one of its three themes.
Our hope is that using the AHSNs’ strong local networks, we can reach many more care homes and help them keep many more elderly and vulnerable people safe from avoidable harm.
You can read more examples in the AHSN Network report, ‘Improving safety in care homes’ at www.ahsnnetwork.com/care-homes-report.