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WOUND CARE TODAY
2017,Vol 4, No 1
WOUND ASSESSMENT CQUIN AT A GLANCE
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CQUIN and wound assessment:
what does it mean for you?
Holistic wound assessment is crucial if wound healing and symptom management are to be
achieved within a recognised timeframe, yet a study by Guest et al (2015) illustrated that there
are gaps in practice and no standardisation in approach. In England, a CQUIN indicator has
been set for 2017–19 to improve the assessment of wounds. Here, Jackie Stephen-Haynes and
Rosie Callaghan, highlight what that means for you.
A systematic approach to holistic
wound assessment is essential for the
delivery of high quality wound care.
The findings of thorough assessment
are key to gathering information
on patients and their wounds. This
information should be documented
at each review so that it can act as
a baseline against which wound
progress can be tracked and used to
guide management decisions.
Inaccurate or total lack
of assessment can result in
inappropriate care and delayed
healing, unnecessary patient
suffering, poor outcomes and the
inadequate use of resources.
CURRENT GAPS IN
CLINICAL PRACTICE
Research by Guest et al (2015)
highlighted that in 2012/13, 4.5%
of the population had a wound,
accounting for 40.6 million healthcare
visits. However, it also revealed
issues with wound assessment
and documentation. For example,
over 30% of patients did not have
a differential diagnosis of their
wound. Importantly, more than half
of patients with wounds did not
heal within the study year (Guest et
al, 2015). Thus, the study revealed
that there is significant scope for the
improvement of clinical outcomes as
well as achieving essential financial
savings. These findings have gone
some way to putting wound care
on the map and has led to the
development of a CQUIN indicator
for the assessment of wounds.
WHY CQUIN?
NHS England has introduced the first
set of two-year CQUIN indicators
2017–19 (NHS England, 2017).The
object of this timescale is to‘provide
greater certainty and stability on the
CQUIN goals leaving more time
for health communities to focus on
implementing the initiatives’(NHS
England, 2017).The overall aim of
setting 13 CQUIN indicators for this
period is to help achieve the goals
of the NHS mandate (Department
of Health [DH], 2017), in which the
Government sets out priorities for NHS
England to ensure it is fit for purpose.
Importantly, the mandate to
NHS England has gone further than
previously to ensure that the best
care is delivered to NHS patients,
and that the reform and renewal
needed to sustain the NHS for the
future is actioned. Thus, the overall
objective of the CQUIN indicators
for 2017–19 is to enhance quality and
improve outcomes for patients. This
includes reducing health inequalities,
encouraging collaboration across
different providers, and improving the
working lives of NHS staff.
CQUIN indicators give a
clear framework for healthcare
professionals to follow, ensuring
cross-country standards for care
within targeted therapeutic areas.
Interestingly, CQUINs only operate
with NHS England. Wales, Scotland
and Northern Ireland have devolved
health care to their local governments.
CQUIN INDICATOR: IMPROVING
THE ASSESSMENT OF WOUNDS
The CQUIN indicator for improving
the assessment of wounds aims to
improve the assessment process in
patients with a wound that is still
unhealed following four weeks of
treatment. Continual reassessment
and documentation of a minimal data
set of findings will be required to meet
CQUIN targets.
There will an initial audit in the
autumn of 2017 with the first report in
November 2017 with a second audit
in Spring 2018.The financial aspect
of the CQUIN will be based upon
demonstrating an improvement in care
provided and will be agreed with local
clinical commissioning groups (CCGs).
WHY IS IMPROVING WOUND
ASSESSMENT IMPORTANT?
There are two principle reasons why
wound assessment has been targeted:
a need to improve the quality and
consistency of care delivered, and a
need to reduce the cost burden of
wounds. NHS England is driven by
achieving the best clinical outcomes
for patients, while also focusing on
financial outcomes that are justified.
While literature and best practice
documents regarding wound
assessment exist, there are currently
no nationally accepted guidelines that
will allow the comparison of wound
assessment across regions. To rectify
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What is CQUIN?
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CQUIN is an acronym for
Commissioning for Quality
and Innovation. It is a
system designed to make a
proportion of any healthcare
provider’s income dependent
on the provider being able
to demonstrate planning
to deliver quality and
improvement in an agreed area
of patient care.