Alleviating the pain of pressure ulcers

Thanks to our ongoing improvement work, over 550 acute hospital patients per year are spared the pain and additional treatment required for pressure ulcers, and the associated healthcare costs are consequently reduced. In 2017, we spread the positive impact of our work in this area into care homes too.

Pressure ulcers are a significant cause of harm to people who use health and social care services and they lead to poorer outcomes and experiences. They’re a consequence of remaining in a similar position – such as lying in bed or sitting in a wheelchair – for long periods of time. In addition to the significant pain and discomfort that pressure ulcers cause to patients, they lead to, on average, five to eight days longer stay in hospital as the patient requires additional care and treatment.

The SPSP has supported the prevention and management of pressure ulcers across different care settings, from initial improvement work in acute hospital wards to care homes. To date, there has been a 24% reduction in grade 2-4 pressure ulcers acquired in acute hospitals across Scotland since January 2015. This means that there are 46 fewer people per month – or 552 people per year - in Scotland’s hospitals experiencing the pain and discomfort of a pressure ulcer. This has delivered annual efficiency savings across Scotland of between £2.2 million (if all grade 2) and £5.5 million (if all grade 4).

These reductions were achieved by working with acute teams to understand how pressure ulcers can be prevented (based on evidence) and what conditions are required to support the reliable implementation of those processes. These included support to clinical staff to enable:

  • Effective assessment and review of pressure area damage.
  • Accurate recording of the grade.
  • Care plans that effectively address issues highlighted in pressure ulcer assessments.

Key to delivering these outcomes was the work nationally to:

  • Develop driver diagrams and change packages which provide evidence informed guidance on where to focus improvement work to make the greatest impact.
  • Collect and share data on pressure ulcer rates across Scotland. As well as helping hospitals to target their work on wards with the highest rates, the comparative data also enabled an appreciative inquiry into what was being done differently in the areas with the lower rates.
  • Develop a national learning network, which enabled those working on this improvement challenge to share successes and, just as importantly, failures. The network collaborates on the development of learning summaries and case studies to support the spread of learning and practical tools and resources.

In 2017, we led work in partnership with the Care Inspectorate, Scottish Care and five HSCPs to take the learning from this successful improvement activity in hospitals and apply it into the care home setting.

Care homes reported that participating in the Pressure Ulcer in Care Homes Collaborative helped them to develop a stronger culture of safety in the units, more integrated ways of working, and improved communication and relationships with relatives. All of this enabled them to provide a better quality of life for residents, most notably at the end of life.

Members of the team supporting Abbey Gardens care home residents reflected on their experience of participating within the collaborative. For example, the manager highlighted how the work had impacted on the number of pressure ulcers: while they were low to begin with, they had reduced the rate to zero.

The impact on the team was significant, with improved morale and confidence. There’s now an enhanced culture where learning and improvement runs through everything they do.

The district nurse commented, “It has had an impact on everything that’s happening in the care home. Staff now feel both valued and respected. Before, they were frightened about making changes in case they got it wrong. Now they feel more confident to try things and run with them. It has changed the whole culture… which is more significant than pressure ulcers being reduced by a squidge.”