1. Prevention is Better Than Cure!
Pilot of a SWARM approach to prevent the deterioration of grade 1 pressure injuries
Jackie Dominick, Matron

2. Background Monthly RCA meetings for deteriorating pressure injuries
RCA themes
Existing SWARM for falls
Pressure Injury Collaborative
Safety Huddles

3. How, Who, Where? Discussion with TVNs and Deputy Director of Nursing
Pilot on Middleton and Boxgrove Wards
Ward sisters led pilot
Staff engagement
Attach to datix
Review meeting after 1 month

4. SWARM tool:

5. Current Position

6. Grade 2’s
Since the beginning of the trial we have had….. 0!!!! Avoidable/lapses in care on Middleton and Boxgrove

7. Grade 3’s

8. Quotes
“Using the new form forces you to reflect on what you are doing before developing into a grade 2, and also empowers the HCAs to take actions”
Miranda Cowen,
Ward Sister Middleton
“Swarms highlight risks reduce harm and support and promote timely intervention and safe care . We use
S=  Skin
W= Warning
A=  Attention
R=  Reduces Risks
M= Monitors
S=   Safe “
Michelle Harris, Ward Sister,
Boxgrove

9. Future Plans Roll out to other wards, team days
Use of PDSA cycle (Plan, Do, Study, Act)

10. If you have an idea, try it! If you are going to fail, fail fast!
Takeaway Messages
If you have an idea, try it!
If you are going to fail, fail fast!
Make time for innovation and ideas