T
he management and
treatment of pressure ulcers
has been identified as being
a huge burden on healthcare
resources within the United
Kingdom. Annual costs to the
National Health Service have been
estimated as ranging from £1.4
billion to £2.1 billion (Dealey et
al, 2012). Approximately 4–10%
Evaluation of a dynamic mattress
replacement system within a
community setting
of patients cared for in hospital
will develop pressure damage
(National Institute for Health and
Care Excellence [NICE], 2005), and
it is estimated that up to 20% of
these may occur in the patient’s
own home or within a care home
environment (NHS Institute for
Innovation and Improvement,
2013). Costs to the individual
patient may include the negative
effect to their emotional, physical,
mental and social wellbeing.
Although the effects of pressure
ulceration to the individual are
difficult to quantify, it is recognised
that there is a significant impact
on their quality of life and that
of their families (Moore and
Cowman, 2009).
Lorraine Grothier, consultant nurse tissue viability;
Dominique Bradley, performance analyst, both at
Provide, an independent social enterprise
delivering NHS and local authority community
services across Essex
Within the UK and beyond, pressure ulcers are still considered
largely preventable with national high-profile strategies
highlighting the need for action to reduce this avoidable harm.
Organisations are now monitored on the quality of care they
provide and may be incentivised or penalised depending on
the number of patients with pressure damage occurring within
their care. It is important that local decision-making regarding
the selection of products used for pressure ulcer prevention
and management is appropriately informed. Limited financial
resources and increasing costs of health care challenge clinicians
to be proactive and participative in helping organisations meet
the needs of their patient population. Reducing risk both to the
patient and the organisation will positively influence patient
outcomes. This evaluation sought to determine the clinical and
cost-effectiveness of a dynamic mattress replacement system
across three community hospitals. Based on the available
evaluation data of 98 patients, results indicated a reduction in
both the number and grade of pressure ulcers. In addition, 96%
of patients rated the mattress as ‘comfortable’ to some extent,
and over 98% of staff provided positive feedback regarding the
service received from the supplier. Further work should focus
on comparing the mattress used in this evaluation with other
pressure-relieving equipment.
KEYWORDS:
Pressure ulcers
Prevention
Pressure-relieving equipment
Dynamic mattress
Lorraine Grothier, Dominique Bradley
A pressure ulcer can be defined
as ‘a 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’ (European Pressure
Ulcer Advisory Panel [EPUAP],
National Pressure Ulcer Advisory
Panel [NPUAP], Pan Pacific Pressure
Injury Alliance [PPPIA], 2014).
Development of pressure damage
is often associated with the quality
of care delivered and prevention
strategies implemented (Ousey,
2011). The Department of Health
(DH) introduced a Commissioning
for Quality and Innovation (CQUIN)
target to incentivise organisations
to demonstrate a reduction in the
number of pressure ulcers acquired
within their care (DH, 2012). A
report investigating poor standards
of care in a large acute hospital in
the UK made recommendations
on the importance of applying
fundamentals of care, to include
pressure ulcer prevention as a key
element of maintaining patient
safety (Francis, 2010). Clinicians are
accountable and have a duty of care
to patients (Nursing and Midwifery
Council [NMC], 2008). It is crucial,
therefore, that they are able to
understand the causes of pressure
ulcer development and have the
ability to apply evidence-based
strategies in their prevention
(Ousey, 2011).
In early 2012, the NHS
Midlands and East Strategic Health
Authority launched an initiative
to eliminate 100% of avoidable
pressure damage categorised
as 2, 3, or 4 by December 2012
(McIntyre et al, 2012). An element
of the programme was to improve
standards of care and patient safety.
The focus of this preventative tissue
damage initiative was:
JCN Supplement
2 JCN
2014,Vol 28, No 5 (supplement)
