Decubitus ulcers

UK hospital cuts cases radically

After acknowledging that too many patients were developing hospital-acquired decubitus ulcers (also known as pressure ulcers or bedsores), staff at England’s Royal Liverpool and Broadgreen University Hospitals NHS Trust adopted a zero tolerance approach and prioritised action against bedsore development, which has resulted in a dramatic decrease in cases.

Diane Wake
Diane Wake

Indeed, their efforts proved so successful that the most harmful types of bedsores have been completely eradicated from the trust’s two hospital sites over the past year. Strict protocols include a thorough risk assessment to check every patient for any skin damage within six hours of hospital admission, or when moved from one clinical area to another. An individual care plan is then produced for at risk patients, with advice given about how they can help prevent the development of a pressure ulcer.

Within the hospital a registered nurse checks patients for pressure ulcers at least every eight hours and a weekly report on the incidence of any bedsores is produced where lessons learned are shared with  clinicians and senior nurses. A specialist team of Tissue Viability Nurses (TVNs) works closely with ward staff to advise and support them in care of patients admitted with a pressure ulcer to help them heal and prevent patients developing any pressure ulcers whilst in hospital.

The TVNs currently see about 600 patients monthly. All clinical staff receive annual training in bedsore management and each ward is designated a trained nurse. ‘Preventing patients from developing serious bedsores is something that we are all extremely passionate about,’ Mary Harrison, the trust’s leading TVN explained. ‘Staff education is an important aspect of the role both in clinical practice and in teaching sessions for the multi-professional team. It is a mandatory requirement for all clinical staff to have education on the prevention and management of pressure ulcers.

‘The main success is by engaging with all staff and ensuring that the prevention of pressure ulcers remains a high priority.’ The trust investment in resources to prevent pressure ulcers includes specialist beds and equipment, which are available round-the-clock. Pressure ulcers – which can range in severity from patches of discoloured, skin to open wounds that expose the underlying bone or muscle – arise from damage to the skin and underlying tissue and are commonly caused by body weight pressing down on the skin when people are immobile for long periods or unable to shift their weight. ‘Our aim is to continue to reduce the incidence of hospital acquired pressure ulcers and ensure none of our patients develop an avoidable pressure ulcer,’ added the tissue viability nurse who has 17 years’ experience in this discipline.

Diane Wake, COO and executive nurse, added that the staff cared for over 85,000 patients last year and they are extremely proud that not a single patient developed a serious bedsore. The benefits to patients are huge, and the trust has not only saved on expensive wound dressings as well as nursing time, but also has gained a reputation for its bedsores initiatives, with a number of other units showing an interest in the work.

 Report: Mark Nicholls


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