Report on Pressure Ulcer Incidence Within

Report on Pressure Ulcer Incidence within

The Royal National Orthopaedic Hospital NHS Trust from

April 2007 – September 2007

Introduction

This report demonstrates the incidence of pressure ulcers with in the Royal National Orthopaedic Hospital NHS Trust from April 2007 – September 2007.

Background

Since April 2004 data has been collated from each ward area to establish monthly reports on the acquired pressure ulcer development within the hospital. This is entered onto a pre-programmed database designed by Huntleigh called TRACE. This allows a systematic review of all those at risk and recorded pressure ulcer treatment and progress. These reports are sent to members of Senior Nurse Management and for quarterly audit reports.

Incidence is the rate at which people initially admitted without an ulcer develop one during a specific period of time. (RCN, 2005).

The NICE and RCN guidelines 2001 were adopted by the RNOH and were the fundamental base of good practice guidelines within the Pressure Ulcer Prevention Policy for the Trust. Coinciding with the policy was the change of risk assessment tool to Waterlow, providing an assessment, which fulfilled the NICE guidelines, risk factors. Alongside this tool the RNOH developed a repositioning chart to document the intervention performed for prevention, as recommended by NICE.

Since 2001, NICE and RCN have worked in partnership with a collaboration of stakeholders to critically analyse the literature and research of Pressure ulcer development and have produced an in-depth guideline in its prevention and treatment. The Royal National Orthopaedic Hospital participated with this and the guideline was published in 2005. This will now enable our current policy to be updated.

Data Collection

Data is collected weekly from each ward area using a specific tool. This has been adapted to allow the nurses to enter the most essential data, patient hospital number, date of admission, risk assessment score, number of pressure ulcers on arrival and number of ulcers now.

The data calculated is formulated within the month time scale and of those who are deemed at risk from the risk assessment tool (10 and above).

Report on Acquired Pressure Ulcer Incidence within the RNOH 6th November 2007 Completed by: Rachel Brown, Tissue Viability Nurse Specialist

The incidence rate is then calculated by the following equation:

Number of acquired ulcers within a month X 100 Number of patients deemed at risk within the month

The chart below demonstrates the number of acquired pressure ulcers and grades per month since April 2007- September 2007.

7 6 5 4 grade1 & 2 3 grade 3 grade 4 2 1 0 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07

Acquired incidence rate from April 2007 – September 2007

April 2.5% May 1.7% June 0.8% July 0.3% August 1.5% September 0.9%

The chart below demonstrates the percentage of ulcers acquired at each site from April 2007 – September 2007.

Sites of pressure ulcers from April 2007 - September 2007

27% 30% Sacrum Buttocks Heels 3% 10% Malleoli Other 30%

Incidence per ward

6 5 4 Grade 1 Grade 2 3 Grade 3 2 Grade 4 1 0

n 4 s IU U W a W W W U B G S e S M B H D N M B A O D tr A J m R P I A H D E a le M A E A e o P h c W R t

Conclusions

The data provides us with a clear indication that there is a current increase within the Royal National Orthopaedic Hospital NHS Trust and that the sites of ulcers are predominately heel and sacrum.

The majority of acquired pressure ulcers are reported as grade 1 and 2 (according to EPUAP classification).

There is also a clear indication that the patients deemed at risk is also increasing within the RNOH and therefore suggests that dependency level is increasing.

Recommendations for Practice

The NICE and RCN guidelines (2005) provide the fundamental evidence of the predisposing factors and prevention guidelines in pressure ulcer care and it is for the multi professional teams of the Royal National Orthopaedic Hospital to embrace this and deliver a high quality standard of prevention.

The guideline identifies that each acute area should:

 Perform individualised assessment (whenever the patients condition changes)  Utilise a risk assessment tool  Identify risk factors that may predispose the individual  Perform regular skin inspections  Utilise and have access to redistribution surfaces  Positioning and the resources to provide this (not rolled up towels or sheep skins)  Provide proper seating  EDUCATION and TRAINING

At present the RNOH has a clear policy outlining the above for pressure ulcer prevention, this requires updating to enhance some changes recommended in NICE guidelines 2005.

The clinical areas currently have waterlow assessment tools and turning charts available to assess the needs of their patients, which provides a basis to preventative devices which are also readily available.

Education and training is the fundamental role in raising the profile of pressure ulcer prevention. This along with quality improvements within an interdisciplinary collaboration.

Research  Questions arising from evaluation and change Evaluation process  Reduce occurrence of pressure ulcers Problem Identification  Audit data  Prevalence and incidence  Outcome indicators results  Patient/ carer feedback  Patient/carer feedback INTER-DISCIPLINARY

COLLABORATION

Implementation and Examination of current Change practices  Communication  Identifying those at risk, use Strategy of risk assessment scales  Education and Training and allocation of redistributing devices  Facilitators/ facilitation Evidence  Find, critically appraise and synthesise research on risk assessment, prevention practices, patient experience / preferences, education and training or;  Evaluate suitability of method guideline for local adaptation into a protocol. This will still require the collection of research, information and patient preference The following is also required to raise standards:

 Audit nursing staff about pressure prevention (obtain base line knowledge)

 Analyse why pressure prevention does not occur within the ward areas .i.e. staffing, lack of knowledge, resources

 Investigate pressure relieving equipment in theatre, plaster theatre and x-ray

 Review documentation – pre op, intra operatively, recovery and post operatively

 Develop patient/ carer information booklets to enable patient knowledge and co operation

The role of the Ward Manager:

 Allocate member of staff to be lead within area, to provide audit material, attend meetings and provide feedback to the ward team.

 Evaluate monthly incidence and action plan change to prevent occurrence

 Book and ensure that staff attend training on the prevention of pressure ulcers.

 Ensure that risk assessment and repositioning charts are utilised with planned care documented.

 Report any pressure ulcer, those that are acquired and those, which exist, on patient arrival.

 Ensure that staff use the EPUAP classification of pressure ulcer grading.