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“On Your Marks” campaign helps prevent pressure ulcers

Pressure ulcers, also known as bedsores, are one of the four common harms in the NHS Safety Thermometer. Patients in critical care units are at a higher risk for pressure ulcers due greater severity of illness, immobility, poor nutritional status, longer stays, poor tissue perfusion and other factors.

Liverpool Heart and Chest Hospital NHS Foundation Trust (LHCH) developed a comprehensive campaign, called “On Your Marks,” to help healthcare assistants and support workers prevent hospital-acquired pressure ulcers and improve patient outcomes.

Ensuring the safety of patients

LHCH provides specialist services in cardiothoracic surgery, cardiology and respiratory medicine. The organisation has a vision to be the best in delivering outstanding heart and chest care and research. As part of the LHCH’s safety-focused culture, it launched the “On Your Marks” initiative to reduce the incidence of pressure ulcers amongst its patient population.

The purpose of the programme is to improve outcomes for patients, particularly in the critical care unit, by developing a comprehensive training and education program to enable staff to recognise every incidence of pressure ulcer. This common form of patient harm is associated with lower quality of life, morbidity and mortality. Pressure ulcers and their complications also increase hospital costs.

“The ‘On Your Marks’ campaign acknowledges the important role healthcare assistants and support workers have in pressure ulcer prevention, equipping them with increased knowledge and awareness,” Tissue Viability Specialist Nurse Julie Tyrer said. “This has involved hard work, persistence and determination – a continuous focus on ensuring that this essential care is considered for every patient, every time.”

Because early intervention can help prevent pressure ulcers from developing, LHCH focused on helping clinical staff identify red marks that can be warning signs of pressure damage. Members from the senior nursing team and tissue viability nurses worked closely with staff to reinforce the importance of the effort. A new pressure ulcer scoping process enabled faster evaluations and provided a forum to discuss root causes and plan a course of action.

“From healthcare assistants to senior management, everyone had a part to play,” Julie said. “Ensuring regular engagement with staff, listening to their ideas and thoughts, involving them, then providing regular feedback further promoted the cause.”

Taking recommendations from the National Institute of Clinical Excellence, LHCH configured guidelines in Allscripts Sunrise™ for up-to-date, evidence-based workflows. Nursing staff follow on-screen guidance during assessments and alerts within workflows improve adherence with Trust policies. Allscripts Sunrise also supports the programme by enabling improved clinical coding, ability to remotely monitor patients and auditing capabilities.

Focused effort results in a significant reduction

The LHCH strategy has had a positive impact on reducing hospital-acquired pressure ulcers. The organisation achieved a 63% reduction in pressure ulcers (grade 2 and above) in one year, including an 88% reduction in pressure ulcers related to medical devices. The critical care unit surpassed 100 days “pressure ulcer free” for the first time in many years.

“Staff have been motivated to maintain their longest pressure-ulcer free period,” Julie said. “Giving staff objective data about the effect of their performance has been a powerful reminder of the importance of pressure ulcer prevention.”

LHCH has shared these findings in various places, including through the North West Tissue Viability Network Group and published in Wounds UK.

“Sharing good practice is important, so other Trusts can either consider similar interventions in their workplace or be inspired to do something new and innovative,” Julie said. “We plan wider dissemination through publishing to help achieve more collaboration to reduce harms to patients.”

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