Improving wound management through inter-professional collaboration. Michael Clark PhD

Public View of Wounds

The reality of Clinical Practice

Cost at all- Wales level (£) Impact in Wales 2013-2014 Resource utilised Number in cohort Unit cost (£) Cost (£) Cost at all- Wales level (£) Initial GP visit 78,090 45 3,514,050 8,570,854 Subsequent GP visits 1,249,809 13 16,247,517 39,628,090 Number of dressings 2,344,930 3,964,537 9,669,602 Number of district nurse attendances 703,479 35 24,621,765 60,053,085 Number of out- patient attendances 68,662 120 8,271,711 20,174,905 Number of in- patient episodes 14,697 78,204,577 190,742,871 Total expenditure 134,824,157 328,839,408 Average cost per patient   1726.53

National audit of pressure ulcers, incontinence-associated dermatitis and other wounds Clark M1, Semple M2, Ivins N1, Mahoney K1, Harding KG1 1 Welsh Wound Innovation Centre, Llantrisant, Wales, UK 2 Welsh Government, Cardiff, Wales UK

Risk of pressure ulcer development Mattress allocation   Risk of pressure ulcer development Product type No risk Low Medium High TOTAL Foam mattress 1198 1665 862 663 4388 Other static mattress/overlay 40 223 299 533 1095 Low Air Loss/Specialty bed 1 7 15 23 Hybrid product 2 22 70 101 Dynamic overlay 4 119 186 Dynamic replacement 36 161 323 644 1164 1280 2080 1553 2044 6957

Hybrid mattresses http://www.woundsinternational.com/made-easys/view/hybrid-support-surfaces-made-easy Dynamic hybrids stated to reduce time to obtain and allocate dynamic mattresses from 434 minutes to 0.

Powered Hybrid mattresses in NHS Wales 2017 Health Board Community Acute Abertawe Bro Morgannwg UHB NO ✓ Invacare Aneurin Bevan UHB No information returned Betsi Cadwaladr UHB ✓ Direct Healthcare Cardiff & Vale UHB ✓Being introduced (Medstrom) ✓ Medstrom Cwm Taf UHB Perhaps in future Hywel Dda UHB Powys Teaching Health Board ✓ Community Hospitals (Direct Healthcare, over 200 in use) No acute units

Pressure Ulcer Prevention and Intervention Service Collaboration Pressure Ulcer Prevention and Intervention Service

Evaluation process Show and Tell Lab test Clinical 8 products Infection control Manual handling Clinical engineering Tissue Viability Objective scoring criteria Contact pressures measured at sacrum and heel 10 able bodied volunteers Clinical evaluation within 2 orthopaedic wards

Clinical evaluation

What about the test wards? The two powered hybrid mattresses were used on two separate orthopaedic wards Ward 1 Ward 2 Significance Number of patients 17 18 Age (years), mean (SD) 82.6 (8.3) 74.9 (15.7) NS Length of sitting during day (under:over 6 hours) 7:8 3:6 Risk (PSPS) Low 0 Medium 8 High 9 Low 8 Medium 5 High 5 Significant Able to change position independently (Y:N) 7:10 9:9 Frequency intentional rounding < 2 hours 5 2 hours 10 3-4 hours 2 Other 0 < 2 hours 0 2 hours 2 3-4 hours 13 Other 3

What about the test wards? Differences between the patients nursed on the two wards; Ward 1. Older, higher risk of pressure ulcers, more frequent scheduled nursing (Mattress A) Ward 2. Tended to be younger (but with wide spread of ages), at lower risk of pressure ulcers, less frequent scheduled nursing care. (Mattress B) Not a direct head-to-head comparison of the two mattresses given different patient mix

A Pressure ulcers present at start of evaluation n=5 (Heel n=4; Sacrum n=1) Category II n=2 : Category III n=3 Pressure ulcers developed during the evaluation n=4 (Heel n=4) All Category II

B Pressure ulcers present at start of evaluation n=4 (Buttock n=2; Sacrum n=2) Category II n=3 Pressure ulcers developed during the evaluation n=1 (Heel n=1) Category II

Next steps in WWIC ISO 20342: Assistive products for tissue integrity when lying down. Space identified within WWIC to develop accredited test lab.