Stopping the Pressure through Education & Training

1. Stopping the Pressure through Education & Training Dr Lisa Bayliss-Pratt Assistant Director of Nursing NHS Midlands and East Pauline Milne Deputy Head of Education and Development East of England Multi-Professional Deanery Tracy Burrell Acting Assistant Director of Nursing Blackpool Teaching Hospitals NHS Foundation Trust Lorraine Thursby Service Lead Manual Handling & Tissue Viability George Eliot Hospital Frances Igbonwoke Associate- Safer Care NHS Institute for Innovation and Improvement

2. Dr Lisa Bayliss-Pratt Assistant Director of Nursing NHS Midlands and East

3. Objectives of Session are to: • provide an overview of the Pressure Ulcer education and training workstream • explain the concept of the Pressure Ulcer education and training framework • discuss Pressure Ulcer education and training in the context of a continuous learning environment • share examples of how Pressure Ulcer training can be systematically implemented

4. Cluster Ambition: To eliminate avoidable grade 2, 3 & 4 pressure ulcers by December 2012

6. Linked to: • Stop the Pressure Campaign • SSKIN • Pressure Ulcer Pathway • Safety Thermometer / CQUIN • Intensive Support Visits • Communication and Engagement Campaign

9. IST Learning: Key Findings • Availability and timeliness of pressure relieving equipment • Variable levels assessing competence • Training focused heavily on management rather than prevention • Root Cause Analysis often showed failure to assess correctly, not having appropriate care plans in place • Nursing documentation varied in quality and completion • Non–concordance was regularly cited as a reason for patients acquiring an unavoidable pressure ulcer – this requires further exploration • Many organisations recognised the benefits of using the safety thermometer • Assessing avoidability was variable across the SHA Cluster as a whole

10. Pauline Milne Deputy Head of Education and Development East of England Multi-Professional Deanery

11. Aims of the Pressure Ulcer Education & Training Framework • Clarify roles and responsibilities in relation to pressure ulcer prevention from ‘board to ward’ • Develop learning outcomes relevant to staff groups • Provide easy access to existing learning materials & good practices • Develop a web based platform to host and maximise access to the framework • Explore accreditation of the framework for the future

12. Why a framework… • To share existing good practices • To enable individuals and organisations to determine pressure ulcer education and training needs for their entire workforce • To raise the profile and priority of pressure ulcer education and training across the workforce • To bring together existing pressure ulcer education and training materials into one central accessible repository

13. Structure of the Framework The PU Education and Training Framework includes roles and responsibilities, learning outcomes and education materials for the following: • Patients, Lay Carers and Relatives • Non Clinical Staff • Non Registered Clinical Staff • Registered Practitioner • TV Link Nurse / Clinician • Sister / Charge Nurse / Team Leader / Matron • TV Specialist Nurse • TV Service Clinical Lead • Board Member

14. Content of the Framework • Web based learning package but materials can be saved / printed off / adapted for local use • Examples include: • Patient information leaflets • Mandatory training presentations • Competency workbooks • Toolkits • Research articles

15. Application of Framework

16. Frances Igbonwoke Associate-Safer Care NHS Institute for Innovation and Improvement

17. Equipping to eliminate avoidable pressure ulcers grades 2-4 Primary OutcomePrimary DriversSecondary Drivers • 1.Competency frameworks and workbooks • 2. Buddying/shadowing and mentoring • 3. Webinars, e-learning, DVDs • 4. Learning networks and best practice forums • Access to Knowledge • Building capability to prevent and eliminate avoidable pressure ulcers grades 2-4 by Dec 2012 • Competent care delivery • Knowledge of roles and responsibilities • Assessed competencies Verbal & documented communication by care giver Education materials and resources 3. Learning, sharing and support groups • Patient and carers equipped with knowledge • Continuous Learning • 1. Measurement • 2. Agreed improvement methodology • 3. Knowledge and design of consistent ‘reliable’ care processes • 4. Continuous learning from incidents, tests of change

18. NHS Change Model www.changemodel.nhs.uk Leadership instilled culture of learning Real-time access to knowledge Working and learning collaboratively with all partners, patients and carers A framework for studying and improving care processes to achieve consistently good outcomes Quality incentives and standards lined up to prioritise staff training Robust delivery of ongoing team training and skill building, analysis for and creation of feedback loops for continuous learning and system improvement Systematically monitoring safety, quality, processes for their impact on patient outcomes and efficiency

19. Supporting Resources • ‘Your skin matters’ (Energising for excellence, High Impact actions for nursing and midwifery) http://www.institute.nhs.uk/building_capability/hia_supporting_info/your_skin_matters.html • The Productive Operating Theatre- Consumables and equipmenthttp://www.institute.nhs.uk/quality_and_value/productive_operating_theatre/consumables_and_equipment.html • Harmfree care website http://harmfreecare.org/harm-free-care/ • NHS Change Model: www.changemodel.nhs.uk

20. Tracy Burrell Acting Assistant Director of Nursing Blackpool Teaching Hospitals NHS Foundation Trust

21. The Story from Blackpool: Achieved in the last 3 years: • 64% reduction in the number of Hospital Acquired Pressure Ulcers > Grade 2 over the last 3 years • 33% reduction in the number of patients acquiring a pressure ulcer whilst in their care. Between April 2011-March 2012: • 30% reduction in the number of hospital acquired pressure ulcers • Over 50% of nursing staff undertaken training in pressure ulcer prevention (e-learning and/or pressure ulcer prevention work book).

22. How Blackpool achieved Results (1) A Shared purpose • A stronger focus on prevention of pressure ulcers • Re-energised Pressure Ulcer Prevention Group focussing on improving patient safety and experience through prevention of pressure ulcers • Corporate and local driver diagrams Engaging to mobilise • Increased ownership and engagement from the clinical divisions Leadership for change • Enhancing the Ward manager role • Enhancing the Matron role • Re-focussing of Link nurses

23. How Blackpool achieved Results (2) Rigorous delivery • Introduction of a pressure ulcer workbook that all staff must complete – linked to appraisal/OLM • Introduction of e-learning package for all nursing and Midwifery staff • Matrons’ training as part of accredited development programme • Launch of the Skin and Safety walk round tool (intentional rounding) • Local action plans to improve prevention of pressure ulcers Transparent measurement • New more meaningful reporting format • Revised RCA reporting to standardise with current Trust practice • Tissue viability as a Nursing Care Indicator Metric Spread of Innovation • Share point intranet information site • Revision of TBM

24. How Blackpool achieved Results (3) Improvement methodology • Improvement of clinical systems • Improvement of staff education / skills / competencies • Staff engagement / ownership • Statistical Analysis / Evaluation System drivers • Reduction in preventable harm: • Local Trust target 30% reduction in year 11/12 • CQUIN target - nurse training / education • Improved quality of patient care / experience

25. Blackpool Next Steps: • Engagement with Community staff • Sharing best practice • Improved reporting for community • Standardising practice / documentation post amalgamation • Revise wound care formulary • Improving referral / continuing care systems

26. Lorraine Thursby Service Lead Manual Handling & Tissue Viability George Eliot Hospital

27. An example from George Eliot Hospitals (1) Engaging medical staff right from the start: • Pressure ulcer awareness received by junior doctors on arrival on day one as part of manual handling induction • Further manual handling sessions to further increase awareness • Pressure ulcer prevention training linked in Post Graduate training within first three weeks of induction Result • Doctors actively assessing the patients’ skin on arrival • one inspired consultant gastroenterologist now engaged in the Pressure ulcer change programme taking forward work to reduce pressure ulcers through improving nutrition and hydration

28. An example from George Eliot Hospitals (2) Pressure ulcer prevention, everyone learning, everyone’s business: • Routinely part of manual handling highlighting correct handling techniques to minimise impact of shear and friction on skin; effective use of pressure relieving beds, mattresses and the MUST for all assisted-handling to have slide sheets • Clinical Mandatory Updates: All disciplines including medical staff receive key messages in pressure ulcer prevention from both Manual Handling and Tissue Viability Result:

29. What have we achieved so far? Nurse Sensitive Indicators data for Tissue Viability and Nutrition prior to medical education and launch of Trust PUP campaign (February 2011) Nurse Sensitive Indicators data Q1 2012/13 for Tissue Viability and Nutrition following active medical education in both Tissue Viability and Manual Handling

30. What have we achieved so far? • Last grade 4 hospital acquired avoidable pressure ulcer - August 2011 • Last grade 3 hospital acquired avoidable pressure ulcer - November 2011 • Last year’s final total of grade 2 post 72 hours avoidable/unavoidable pressure ulcers: 154 To Excel at Patient Care

31. Dr Lisa Bayliss-Pratt Assistant Director of Nursing NHS Midlands and East

32. Summary • Building capability to prevent and eliminate avoidable pressure ulcers is a priority • Continuous learning system is key to maintaining a skilled workforce and achieving change at scale and pace • Continuous feedback from YOU!

33. QUESTIONS & DISCUSSION