1. Elimination of Hospital Acquired Pressure Ulcers (HAPUs)
A Wellman (Lead), J Murray, E Green, D Maunder, H Gilbert-Ashur (Project Team)
Background
A pressure ulcer is localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. (NPUAP /EPUAP 2014). The prevalence and incidence of pressure ulcers is recognised as key indicators of the quality of care delivered (Clary, 2000).
It is estimated that within the UK expenditure is in excess of £1.3 – 2.4 billion, equating to 4% of the NHS budget (Bennett, Dealey and Posnett, 2012). The cost to the patient in terms of pain and suffering however; is immeasurable.
Hampshire Hospitals did not achieve the 2014/15 National CQUIN for 50% reduction in HAPUs and instead reported over 300 HAPUs in 2015/16 despite several small projects initiated to address the issue
Overall aims of the project
Eliminate hospital acquired avoidable grade 3 and 4 pressure ulcers by March 2017
50% reduction of hospital acquired avoidable grade 2 pressure ulcers by March 2017
June 2016
- Go live with new documentation, pathways, equipment and audit systems
Results
A template for presentation of a Clinical Audit project.
Example order and structure of slides, together with prompts as to what should be included at each stage
Extra slides can be added to each section as appropriate (e.g. more than one background slide), aiming for each slide to be readable and not too cluttered with information.
Specific Objectives
95% of adult inpatients will have a risk assessment completed within 2 hours of admission
95% of adult inpatients at high risk of pressure ulcers will have a prevention and management care plan in place within 2 hours of risk identified
95% of staff (in areas caring for adult inpatients) will be trained and assessed as competent in pressure damage prevention
Overall improvement achieved in standards of assessment, documentation and provision of care completed
Work streams
Documentation & pathways
Equipment & dressings
Nutrition
Methodology
Baseline audit of training assessment, documentation and provision of care completed
Work streams initiated based on findings
Rapid Spread Methodology used to review and implement new pathways
Cascade training
Re-audit of documentation and care
Training
Audit and Data
Program Timetable
January 2016
- Hot debriefs for all pressure ulcers
February 2016
- Baseline audit of care plans
- Project Launch
March 2016 – Immersion exercise to coincide with appointments of Clinical Matrons
Significant reductions in all grades of HAPUs. 70% reduction in grade 3s and 4s and 30% reduction in grade 2s against 2015/16
Other Findings
Management of moisture and incontinence is a major issue across the organisation
Conclusion
It is possible to eliminate HAPUs through a an approach that addresses all elements of the patient’s journey and targeted staff education.
Further work is needed to identify the actions required to sustain the reduction.
Baseline data suggested that all areas of pressure ulcer prevention needed addressing. Using learning from RUH Bath - Rapid Spread Methodology was identified as best suited for the change required.
March – June 2016 Cascade training
References: Bennett G, Dealey C and Posnett J (2012) The cost of pressure ulcers in the UK. Age Ageing Dealey C, et al (2015) Challenges in pressure ulcer prevention. International wound Journal, 12: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. (2014) Prevention and Treatment of Pressure Ulcers: