Rosie Cameron Project Manager – Tissue Viability Beardmore Conference Centre 23 April 2012

1. Why raise the Pressure? Rosie Cameron Project Manager – Tissue Viability Beardmore Conference Centre 23 April 2012

2. Overview • Impact of Pressure Ulcers • Facts and Figures • Current Work in GGC

3. Definition "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. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors has yet to be elucidated." National Pressure Ulcer Advisory Panel (NPUAP)/European Pressure Ulcer Advisory Panel (EPUAP) 2009

4. Impact for Patients • Pain and discomfort • Quality of Life • Significant difficulties

6. Grade 4 pressure damage

7. Severe skin excoriation

8. Impact for Organisation • Increased bed days • Increased workforce time • Increased prescribing • Litigation

9. WHY? The majority of pressure ulcers are preventable! Think……

10. Facts and Figures • 1 in 10 patients across Europe have a pressure ulcer. 50% of those are Grade 3 and 4 (Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel, 2009) • 50% of patients who develop a severe ulcer will die within 4 months (Bliss ) • 90% of Grade 1s are reversible with adequate nursing intervention (Bader)

11. Facts and Figures • Estimated 4% of healthcare expenditure • Costs NHS £2 Billion per year

13. WHY? The majority of pressure ulcers are preventable! Remember……

14. Facts and Figures • FOI requests • Sensational Headlines

15. Facts and Figures - Deaths • Scotland - 78 people died as direct result of infected pressure ulcer • Scotland - 566 cases mentioned pressure ulcer as underlying cause or contributory factor • GGC - 11direct result - 97 contributory factor

16. WHY? The majority of pressure ulcers are preventable! Remember……

17. Current GGC Work Streams • Strategic Steering Group • Partnership Group • Tissue Viability Specialist Nursing Team • LBC – Revised CQI • SPSP (Primary Care) • eHealth

18. NHSGGC – Tissue Viability High Level Project Plan Primary Drivers Secondary Drivers Aim: To reduce the overall incidence of pressure ulcers across GG&C. Corporate Measures of Improvement by 01 April 2013 50% reduction of Grade 3 and 4 pressure ulcers 100% Pressure Ulcer CQI reporting by all appropriate wards and Partnerships 100% Datix reporting of Grade 3 and 4 pressure ulcers 50% reduction in number of people admitted for pressure ulcer care Monitoring of cost benefits of single Wound Formulary Support and involve patients and families Ensure appropriate assessment and treatment Optimise care transitions to home or elsewhere PERSON CENTRED Prevent pressure ulcers by implementing SSKIN bundle Implement PU Safety Cross across all Wards and Partnerships Promote Corporate education/awareness of prevention SAFE Reduce Waste, Variation & Harm through promotion of EBP: National Tissue Viability Programme Releasing Time To Care Programme – CQI for Pressure Ulcer Scottish Patient Safety Programme in Primary Care Joint Wound Care Formulary EFFECTIVE Eliminate waste in referral processes to TVN Service Eliminate waste in use of unnecessary equipment Monitor compliance with Wound Care Formulary Use of eHealth solutions EFFICIENT EQUITABLE 1. Consistent development and implementation of policies, procedures, guidelines and work plans 2. Reduce variation in access to TV service 3. Improve access to appropriate equipment and supplies TIMELY Skin inspection and assessment of risk Efficient referral systems September 2011 v3

23. ALL GRADE 3 & 4 REFERRALS TO ACUTE TVN SERVICE April 2011 - March 2012

25. WHY? To Summarise • COST • Patient Safety – every patient, every time • You have the resources/tools

26. Over 95% of pressure ulcers are preventable! Remember……