JCN supplement
Risk assessment
Early detection
Implementation of
prevention strategies.
This ‘Stop the Pressure’
campaign
.
com) included videos, online
resources and documentation to
support clinicians in their day-to-
day practice. A SSKIN care bundle
was also introduced as part of the
strategy. This was used to address
the key elements of care required
for an effective framework
of pressure ulcer prevention, as
SSKIN denotes:
Surface
Skin inspection
Keeping your patients moving
Incontinence/moisture
Nutrition.
This care bundle is seen as
a structured way of improving
processes of care and positive
patient outcomes, and increases
the likelihood that clinicians will
acknowledge and address every
component to this sequence of
assessment steps with appropriate
intervention (NHS Institute for
Healthcare Improvement, 2014).
Failure to follow this systematic
approach may increase the potential
for the development of pressure
damage (Stephen-Haynes, 2011).
Patients may have multiple risk
factors, but it is well recognised
that immobility is considered to
be one of the major contributory
factors predisposing a patient
to pressure ulcer development
(EPUAP/NPUAP/PPPIA, 2014).
Frequent patient repositioning and
the use of appropriate pressure-
relieving devices, including
mattresses and cushions, can
reduce the likelihood of a patient
developing a pressure ulcer and
should form part of the prevention
strategy (Guy et al, 2013).
Dynamic support surfaces are
routinely used in the prevention
and management of pressure
damage and are of benefit
when patients do not have the
ability to reposition themselves
independently (NICE, 2014). The
provision of dynamic pressure-
relieving devices is a cost factor
to any healthcare provider
organisation, and although a key
consideration, clinical-effectiveness
and optimum levels of service
must be of equal importance
in any procurement process.
Clinicians should have the ability
to rationalise their decisions
when selecting an appropriate
support surface for pressure ulcer
prevention or management, and
have an understanding of the key
features and benefits of pressure-
relieving/reducing devices and how
to operate them safely (Fletcher et
al, 2014).
importance of gathering clinical
feedback of product evaluations
within a hospital setting. The
consultant nurse for tissue viability
initially sought agreement from
the organisation to conduct
a pilot clinical evaluation to
include 20 inpatients. During
the pilot study, an alternating
air mattress replacement system
(Dual Professional) was provided
by Shelden Healthcare Ltd, as a
suitable replacement to existing
products for the purpose of
identifying one standard dynamic
pressure-relieving mattress system
that could be used across the
selected ward areas. The pilot study
attempted to explore clinician and
patient experience while using
Dual Professional. Due to the
overwhelming positive feedback
regarding the product and the
service received, it was decided
by the organisation
to continue
using the product under a rental
agreement and to evaluate a further
80 patients, which would increase
the dataset to 100 participants.
Sample
The community hospitals have a
total of 70 inpatient beds, each with
a specific focus on rehabilitation,
stroke and end-of-life care. Patients
who were admitted into one of
the three community hospital
wards between September 2013
and March 2014 were eligible to
take part in the evaluation. Seven
hundred and seventeen patients in
total were admitted onto the wards
during this timeframe; of these,
20 patients were recruited into the
pilot study and a further 80 were
recruited into the study overall
(14% of all admissions). A total
of 98 patients’ data were included
within the evaluation (two patients
died during their episode of care
and were withdrawn).
Using the Waterlow risk
assessment tool (Waterlow,
2005) and clinical judgement,
patients included were assessed
as being at high risk and very
high risk of developing pressure
damage. Patients considered at
low risk were offered alternative
pressure-relieving/redistributing
‘Frequent patient
repositioning and the use of
appropriate pressure-relieving
devices, including mattresses
and cushions, can reduce
the likelihood of a patient
developing a pressure ulcer
and should form part of the
prevention strategy’
To support the local strategy
for pressure ulcer reduction, an
audit was conducted across three
community hospital wards with
the aim of identifying the dynamic
pressure-relieving equipment in
use. This audit highlighted a vast
range of available equipment that
was both owned and rented, and
which was ageing and costly and
in need of frequent repair. With
such a varied array of equipment,
staff reported difficulty in being
familiar and confident with the
effective operation of all of the
individual dynamic systems, which
had the potential to increase clinical
risk. The organisation considered
it important to streamline the
availability of products for clinician
ease, cost-containment and
maintenance of patient safety, in
conjunction with service need
and demand.
Shelden Healthcare Ltd have
a wide experience of supplying
pressure-relieving mattresses
predominantly to the nursing
home setting, but understood the
JCN
2014,Vol 28, No 5 (supplement)
3
