SSKIN Bundle Implementation

1. Progress and Benefits SSKIN Bundle Implementation WSCNTL 2014, Kings Hall Leading Care, Leading Teams - Innovating and Supporting Person-Centred Care WSCNTL 2014, Kings Hall Leading Care, Leading Teams - Innovating and Supporting Person-Centred Care

2. ‘The very first requirement in a hospital is that it should do the sick no harm’ – Florence Nightingale.

3. Key Documents • HSC Board and PHA commissioning Plan 2013/14 (January 2013)(working draft) states: “ Pressure Ulcers – Trust will spread the skin bundle to 80% of all adult inpatient areas/wards ensuring 95% compliance by March 2014. Trust will monitor and provide reports on bundle compliance and the rate of pressure ulcers per 1000 bed days”

4. The Quality and Safety strategy provides the foundation for a Trust wide approach to improvements in Quality and Safety and there is strong Executive Leadership and support enabling us to achieve the targets of the PHA of 80% implementation of the SSKIN Bundle into the acute sectors of the WHSCT by March 2014.

5. What Does the Evidence Tell Us? • Risk is predictable • age immobility, incontinence, poor nutrition, sensory problems, circulation problems , dehydration and poor nutrition • Skin Integrity can deteriorate in hours • Frequent assessment prevents minor problems from becoming major ulcers • Wet skin is more vulnerable to skin disruption and ulceration • But dry skin is a factor as well • Continual pressure, especially over bony prominences, increases risk • Pressure relieving surfaces work Reddy et al JAMA 2006;296: 974-84

6. Pressure Ulcers • They are not always simple wounds that eventually heal with the right treatment. • They can have devastating effects on the quality of life for both patients and their families. • They represent a major burden to patients, including negative psychological, physical and social consequences affecting health, well-being and health related quality of life.

7. Pressure ulcers – why prevent them? Human Cost. Approximately 412000 individuals will develop a new pressure ulcer annually in the UK. Prevention and treatment cost between £1.4 to £2.1 billion annually. The cost of treating a pressure ulcer varies from £1,064 - £10,551 Which is 4% of the total NHS expenditure. Bennett et al (2004)

8. The Journey Began • Trauma and Orthopaedic Ward

9. A new direction? • Quality Improvement Methodology • Shifting the focus to Prevention • Real time measurement • Partner with Patients and families • Making the connections

10. We need to reliably implement all elements of the SSKIN Care Bundle. • S SURFACE • S SKIN INSPECTION • K KEEP MOVING • I INCONTINENCE • N NUTRITION All elements of the SSKIN Bundle must be evident and effectively carried out or it will not be counted as compliant.

11. METHODS • Spread Plan developed in the form of a GANTT Chart. • High risk wards identified – Trauma Unit • Using PDSA methodology implemented essential elements of the SSKIN Bundle. • Engagement with all members of Multi Disciplinary Team. • Ward based education seminars organised. • Promotion of visual cues, information sheets and Safety Cross • Champions appointed to each area to support colleagues. • Staff supported to carry out audits of compliance. • Strong Executive support.

13. Staff went from accepting pressure damage as inevitable to scrutinising care to ensure everything was being done to prevent pressure ulcers from occurring.

14. In 1 year they reduced the occurrence of Pressure Ulcers by 47.5%. • Delivering an economic saving of £187,000 (using DOH Calculator)

15. Patients as partners • “ If quality is to be at the heart of everything we do, it must be understood from the perspective of patients.”