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Stop the Pressure- The Campaign

lisa-baylissThe ‘Stop the Pressure’ campaign was launched in the Midlands and East to eliminate avoidable grade 2, 3 and 4 pressure ulcers in 2012. Avoidable pressure ulcers are a key indicator of the quality of nursing care. Preventing them happening will improve all care for vulnerable patients.

 

  • Pressure ulcers cause patients long term pain and distress
  • Pressure ulcers can mean longer stays in hospital
  • 80-95% of pressure ulcers are preventable
  • Treating pressure ulcers costs the NHS more than £3.8 million every day.

The first year of the campaign saw providers in the Midlands and East of England achieving a 50% reduction in new pressure ulcers. This was largely delivered by raising awareness of the causes of pressure ulcers via an extensive communications strategy, understanding the early warning signs, taking preventative measures and utilising SSKIN and the NHS Safety Thermometer.

Student nurses have been holding a series of conferences to raise awareness of this campaign – who are now spreading and cascading the information needed to help ‘Stop the Pressure’.

The first student conference in October 2012, brought together 450 student nurses and since then there have been a number of other events held across the country in Leeds, Teesside and Salford with a focus on raising awareness of the campaign and spreading this important learning.

Throughout November 2014 there is a range of planned activity to support this campaign with the highlight of this month being World Stop the Pressure Day on 20 November. There will be a national conference in London supporting the day – that you can attend.

Visit www.stopthepressure.com) for more details.

Professor Lisa Bayliss-Pratt, Director of Nursing for HEE says:

“I am excited to see the involvement of so many student nurses in this campaign and as the Director of Nursing for HEE I want to pledge my support for the stop the pressure campaign. We are now in the winter months and it is more important than ever to avoid unnecessary re-admission to hospitals and eliminate harm to our patients.

#stopthepressure

The pressures of November

44Who Cares ConferenceAs we prepare for the winter months and the demands they can bring for the NHS, nurses and health care assistants, it strikes me that we need to continue doing all that we can to avoid unnecessary re-admissions to hospital and eliminate harm to our patients and service users as we continue to strive to deliver the best possible compassionate care.

It is timely that, with November comes ‘Stop the Pressure’ month. During November we will take the opportunity to celebrate the achievements to date in reducing pressure ulcers at a national level and will look at how we can share examples from across England, where the greatest improvements have been seen.

The ‘Stop the Pressure’ Campaign was launched in 2012 by Ruth May, Regional Chief Nurse for the Midlands and East Region.

In the first year since the campaign was launched, they saw a 50% reduction in new pressure ulcers across the Midlands and East region. This was largely delivered by raising awareness of the causes via an extensive communications strategy, understanding and identifying the early warning signs, taking earlier preventative steps as part of SSKIN and using the NHS Safety Thermometer.

Based on the success achieved through the campaign in its first year, and with the support of NHS England, the Midlands and East team led a national ‘test’ roll out between October 2013 and March 2014 in conjunction with NHS IQ and Haelo. The results highlighted the importance of maintaining focus on this issue, working collaboratively and the positive results that can be achieved.

Additionally almost 2,000 student nurses have been able to access the latest knowledge, research and techniques through the delivery of a series of student nurse conferences. Subsequently a small number of students across the country are working closely with the Stop the Pressure campaign to take a lead role and spread their learning and good practice tips with their nursing colleagues and fellow students.

There are many great examples to learn from; the PU Web Path and the ‘Love Great Skin’ initiative led by Wounds UK and NHS England which is underway with the care homes sector.

As positive as this is, there is still much more to do and I am confident that we can continue making significant improvements in this area. It will require individuals and organisations to communicate and work together to achieve our goal of eliminating avoidable pressure ulcers. We have already gained the support of a range of organisations and professional bodies including the Royal College of Nursing, the Tissue Viability Society, NHS IQ and Nursing Times.

I will personally be focusing on this issue at my CNO Summit later this month, with 500 senior leaders from across health and social care to discuss what we as senior leaders can do to maintain focus, educate and support our nurses and health care assistants to continue this excellent work.

I call upon every senior nurse leader to make this a priority focus with their teams throughout November to support us in raising awareness even further about pressure ulcer prevention and treatment, and in improving the experience of everyone in our care this winter.

Each week of November has a specific focus on pressure ulcer prevention activity; risk assessment, prevention, treatment and audit & review. During each week there will be opportunities to get involved in a wide range of different activities. Details can be found on the Stop the Pressure website. Please visit the website and take the opportunity to read about some of the work that is happening across the country, consider what else you can do to work towards this in hospitals, care homes, acute wards, and please share your initiatives and results so they can be shared with others.

November 20th is ‘World Stop Pressure Ulcer Day’ and a one day conference is planned with the theme of “Whats your Contribution”. This event is being supported by the RCN and will be hosted at its London headquarters. Key speakers include Dr Mike Durkin (Director of Patient Safety, NHS England) and Ruth May (Regional Chief Nurse, NHS England, Midlands and East).

I would like to say a huge ‘thank you’ to all our nurses and health care assistants, who are working in a variety of health and care environments, for their unwavering commitment and hard work for this profession. I am very proud to lead such an amazing group of professionals. So please remember, no matter how busy it becomes over the next few months, this is one area where we can continue to really make a difference.

 

By Jane Cummings, Chief Nursing Officer England

 

Pressure at work

Trish Morris-Thompson_Picture ViewerI was delighted to be asked to contribute to the ‘Stop The Pressure’ campaign because as Barchester Healthcare’s Director of Quality and Clinical Governance and as a nurse I know it’s a vital subject. So here’s the story of an ongoing Barchester initiative that I hope will inspire people to begin campaigns of their own.

 

Barchester Healthcare provides nursing support for a very wide and diverse range of the population – around 11,000 people in over 200 homes, supported by 17,000 staff, which includes about 2,400 nurses – with many of the individuals we support at high risk of pressure damage.  Healthy skin is important to everyone but it can be a matter of life and death for the often frail individuals who choose our care. Our initiative raised the profile of pressure damage and stressed importance of a ‘back to basics’ approach, emphasising the importance of noting those small changes in a person’s wellbeing that can make all the difference, on a daily basis.

We called the Barchester Healthcare awareness campaign to help staff deliver and promote good skin care MI SKIN, standing for ‘Movement’, ‘Ill’, ‘Sore’, ‘Keep monitoring’, ‘Incontinence’, and ‘Nutrition’. It’s a trigger tool for identifying changes in the individual and for promoting staff awareness of potential problems.

Everyone admitted to our homes is assessed against the MI SKIN criteria within six hours of admission to the home. Staff identify individuals particularly at risk, including anyone with impaired cognitive or sensory capabilities, with impaired communication ability, people who spend long periods sitting or lying down, people whose nutritional intake is inadequate, people whose skin is frequently moist and anyone undergoing surgery.

In homes staff see MI SKIN posters and a safety cross in the nurse’s stations.  The safety cross maps progress on preventing skin damage: a green day means no pressure damage, an amber day shows somebody admitted with pressure damage and a red day means that pressure damage has occurred, so staff need to understand why.

The MI SKIN initiative developed to include nurses, all care staff and an action plan for every individual home. Relatives play an important part, too: care staff know to report any concerns they raise immediately to a nurse. The initiative has become an element of handover discussions and is embedded in care staff’s thinking, ensuring that clinical information and changes to an individual’s well-being are highlighted, so that preventative action is taken.

Here’s how we implemented the initiative: a week-long email campaign to raise awareness was followed by Barchester’s Care Specialists holding regional workshops in July. These had a practical element: at the workshops homes wrote an action plan on how to launch the MI SKIN Matters Campaign within their homes. Supplementary documentation further raised awareness, like the NPSA Safety Cross used in all clinical areas and a mattress selection algorithm to encourage staff to make the correct choices in surface provision.

Courses run regularly, with an interactive workbook. It involves work and discussion with a MI SKIN-trained mentor, case studies, quiz-style questions and action planning, supplemented by e-learning. It also takes the individual through the use of the mattress algorithm.

The initiative prospered and grew because staff could see that it had real impact on residents and their quality of life. It derived its momentum from care staff rather than as a ‘top down’ initiative, with staff going to nurses with any concerns about risk factors.

Nurses ask themselves questions such as is the individual eating and drinking adequately? Are they able to change their position easily? Is pressure over bony prominences minimized? Does reducing sitting time need to be considered? May a medication change put the individual at risk? What creams may be prescribed and used?

There is already clear evidence showing successful integration and use of the MI SKIN Matters resources into the homes. We are continuing its momentum by aiming to lower the number of home-acquired pressure ulcers by 25% in the coming year. This is a target for our homes’ Clinical Improvement Plans, which feeds into the Quality Account we choose to write voluntarily for our nursing homes.

Wish us luck – and why not try something similar for yourself!

 

Trish Morris-Thompson,
Director of Quality and Clinical Governance,
Barchester Healthcare

 

Trish.morris-thompson@barchester.com
Twitter: @barchester_care

Prior to her present role Trish was Nurse Advisor to the Care Quality Commission and Chief Nurse for the London Strategic Health Authority. She is Visiting Professor of Nursing and Midwifery for Bucks New University and this year was voted onto the Nursing Times Leaders list.

Moving through the years…

hiediI am often asked how I got into Tissue Viability and as it was because of pressure ulcers I thought I’d start my first blog by telling that story. Not long after qualifying as a registered nurse in 1987 I read an article in The Nursing Times entitled “Are you in the dark” by Denis Anthony. In this article Denis informed us about best practice for the prevention and management of pressure ulcers. He advised against using the wound treatments we used on the orthopaedic ward I was working on. He mentioned dressings called granuflex and kaltostat and advised wounds might heal quicker if these are used. He mentioned alternating air mattresses, something else we didn’t have. All we had were sheepskin bed pads and a rotating net bed.

 I was hooked, and lucky enough to have a proactive ward manager who was receptive to change. She encouraged me to investigate further, find and read the evidence (my first literature review) and introduce the changes to our ward. She supported me attending my first conference: The 4th National Pressure Sore Symposium in Bath on 20th April 1988.

It was here that I saw Pamela Hibbs present her economic evaluation of how much treating pressure ulcers costs and heard her tell us that it was her belief that 95% of all pressure sores were preventable. This had a huge impact on me and preventing pressure ulcers became a goal.

Moving through the years I became the local resource for all things wound and pressure area care in each job I moved into. In 1989 I had an interview for a district nursing post. In this interview they asked me where I saw myself in 10 years time. “I’ll be a wound care specialist nurse” I replied. With family commitments this took me a few years longer and in 2002 I was able to create my own job and became a tissue viability nurse along with Dianne Brett who leads the service.

In these 11.5 years our team has standardised documentation, introduced guidance, introduced a total bed management scheme and most importantly educated, educated and educated some more. Yes, we saw our annual hospital acquired prevalence decrease but patients were still getting pressure ulcers. Why? We had the mattresses. We had the beds. We had some level of interest from our exec team, after all they were financially investing in us and the equipment. Our staff knew repositioning and skin inspection was key. But some patients were still getting pressure ulcers. What more could be done to protect them from this harm?

We introduced root cause analysis for all hospital acquired pressure ulcers in 2010 and began reporting numbers to the Trust board as well as analysing the themes behind the causes.

Internationally it seemed that interest in pressure ulcers was  developing at the highest levels of healthcare.

In 2012 the Stop The Pressure campaign was launched by NHS Midlands and East SHA cluster. I was lucky enough to be involved in the communications arm of this campaign. Whilst the clinical expert group were building a pathway for clinicians to follow for prevention and treatment, The comms team were responsible for getting the message out there using a wide variety of different methods.  Along side this we had financially driven local targets around the reduction of avoidable pressure ulcers.

The multi-faceted campaign was a huge undertaking for the SHA but their commitment and approach to it was inspiring. Tissue Viability Nurses were involved as clinical experts and steered the content and clinical pathways that were produced.  We had standardised processes in place for reporting and investigating. The SSKIN care bundles were introduced and adopted across the region.

As our pressure ulcer incidents starting to decrease even further we were able to switch focus at ward level to the number of pressure ulcer free days rather than the number of patients with pressure ulcers. This was an extremely motivating tactic and ward staff became very proud of their number of free days. More importantly – this encouraged a belief that pressure ulcers are largely preventable. We know more now about those that are unavoidable and we have systems and processes in place to help determine when this is the case. However, over the last few years we have prevented many pressure ulcers – we just don’t know which patients successfully didn’t get a pressure ulcer. All we know is that many hundreds didn’t – where they might have done in earlier years.

 

Heidi Sandoz (previously Guy)
Clinical Lead for Wound Care
Honorary Lecturer University of Hertfordshire Accelerate Health CIC Mile End
Hospital Bancroft Road London E1 4DG

I never thought it could happen to…

Michael_McGrath_Portrait_APPROVEDHaving written various blogs and articles over the years on different subjects, nothing comes close to the responsibility I’ve felt in writing this one in support of the #StopThePressure movement. Remember every great cause begins as a movement and this one is no exception! Right at the heart of it are tens of 1000’s of supporters (predominantly healthcare professionals) who are taking action every day in pursuit of a common goal to ultimately eliminate pressure ulcers.

Whilst there continue to be many successes evidenced not least by the Midlands and East NHS Region’s 50% reduction in avoidable category 2, 3 and 4 pressure ulcers, I believe that the vast patient carer community sadly remain oblivious of the associated risks, what to look out for and what to do. This belief stems from leading on several patient and carer Focus Groups in support of a wider research programme commissioned by the NHS Midlands and East Region seeking to understand how to ‘motivate’ and ‘educate’ patients and carers around preventing pressure ulcers.

Not forgetting that pressure ulcers can affect anyone, those that read this blog may or may not be tuned-in to the growing number of ‘at risk’ vulnerable groups many of whom I’ve personally met. By definition, these include people with a disability, people in care homes (as well as those receiving care at home), people in hospital or those that perhaps have had a recent hospital stay, those who work in and attend hospices, those in wheelchairs (like me) in addition to the increasing number carers across the country all of whom would benefit from a little education. So how is the #StopThePressure movement going to connect with millions of people across the country? 

I believe that in order to ‘educate’, ‘motivate’ and ‘empower’ the public at large in learning how to prevent pressure ulcers, we need a hard hitting, almost shocking campaign that shows the severity of pressure ulcers by using powerful images that create an emotional response. It should be memorable but also give real hope by reminding people that up to 95% of pressure ulcers can be prevented.

Let’s take a quick look at just one of those at-risk groups i.e. those who use wheelchairs. It’s estimated that roughly 2% of the UK population equating to some 1.2 million people are wheelchair users in England – FACT. Of these, approximately 825,000 regularly use NHS wheelchair services – FACT. This is one of many key ‘educational’ channels where a cost effective prevention message could really help in not just reinforcing but uplifting users knowledge in ultimately taking personal responsibility.

 Much has been written about the UK’s ageing population which as we all know has considerable consequences for public services. You may be surprised to know that 72% of wheelchair users are over the age of 60yrs – my point is simply that one of the most important risk factors that cause pressure ulcers (if not the most!) is that of immobility, something that I’m now acutely aware of in making sure that I keep moving! At some point in our lives, we may all be at risk of getting a pressure ulcer, and that’s a fact!

Now I’m no healthcare professional but even my eyes watered when I first heard that the cost of pressure ulcers to the NHS is somewhere between £1.4 and £2.4billion each year. Whilst the economic case for investment speaks for itself, it’s my belief that any prevention strategy must ‘speak’ directly to and ‘engage’ with those ‘at-risk’ vulnerable groups, people like 18yr-old powerchair user Jack who has Duchenne Muscular Dystrophy.

I vividly recall Jack’s father who attended one of our patient/carer Focus Groups at a hospice in Bedfordshire sharing a story about his son’s new trendy trainers and why he couldn’t understand why his feet and toes hurt for no apparent reason. Jack would wince every time his dad put his socks on but neither thought anything of it! Just a few days later after having reverted back to his old trainers, Jack’s father observed two red weeping sores the size of a 10p coin on both of his son’s heels. “I never thought it could happen to … Jack, I had no idea, I couldn’t understand what was going on but what I now know I’ll never forget. Jack now insists we check him everywhere!”

Most if not all of the different ‘at-risk’ vulnerable groups I’ve spoken to over the past year remembered the British Heart Foundation’s hands-only CPR ‘Hard and Fast’ campaign ‘ that captured the nation’s imagination thanks to footballer-turned-actor Vinnie Jones carrying out CPR to the disco song “Stayin’ Alive” by the Bee Gees. Not only did it capture people’s attention but two years on people still make the connection to the campaign’s underlying message. Perhaps the time has come to consider an approach to Robbie Williams, Lady Gaga or maybe Justin Bieber … ideas to Lyn McIntyre on a postcard please :)

When collecting my thoughts in providing some closing #StopThePressure remarks for this blog, two people came to mind – the founder of modern nursing, often referred to as the ‘Lady with the Lamp’, Florence Nightingale who in 1859 wrote, “If he has a bedsore, it’s generally not the fault of the disease, but of the nursing” and the other who in 1943 became the director of the new National Spinal Injury Centre at the emergency medical services hospital at Stoke Mandeville, who founded the Paralympic movement … of course I speak of the remarkable Professor Sir Ludwig ‘Poppa’ Guttmann. Both were presented with impossible challenges, both had steadfast views about how to address pressure ulcers, both possessed that pioneering spirit and in my humble opinion, both were ‘game changers’ or ‘champions of change’.

The #StopThePressure movement already has many ‘champions’ as evidenced most recently by the surge of interest, enthusiasm and commitment from the student nurse community. I applaud the fantastic energy and work going on in this space and whilst I wholeheartedly subscribe to the prevention message, I’m struggling a little with the notion of having an ambition where pressure ulcers become ‘sexy’ as indicated by a Lead Tissue Viability Nurse at the United Lincolnshire Hospital Trust. However you interpret this colourful observation, I suspect that Jack’s father might have something to say about it!

My wife and I will continue to play our part in helping drive further awareness and look to establish like-minded partnerships that can facilitate knowledge sharing and ultimately ensure that the impact of the prevention message is heard far and wide. Additionally, we’re urging as many people and organisations that we’re communicating with on specifically the pressure ulcer agenda to link up with NHS Change Day taking place on Monday 3rd March 2014 … the countdown has begun!

In March 2014, it will be three years since we first heard about pressure ulcers at a presentation given by Ruth May as part of an NHS Midlands and East Emerging Leaders Programme. This was an event at which I had been invited to deliver the keynote address on the subject of leadership in times of change. Whilst change is often unsettling (something I’m sure those who worked with Florence Nightingale and Ludwig Guttmann experienced), it’s something that I have embraced and indeed befriended because I never want to be in the position of saying … I never thought it could happen to… me!

 

Michael McGrath
Director – Michael McGrath Management Services Ltd
www.michaelmcgrath.co.uk
Inspirational Business Speaker, Consultant, Disability Champion, Change Agent, Adventurer
The first disabled person in the world to have successfully led expeditions to both the North and South Poles
Twitter: @MichaelMc_Grath

Founder, CEO – The Muscle Help Foundation
Registered Charity No 1096716
www.musclehelp.com

 A specialist family charity delivering highly personalised experiences in the UK for children and young people with the muscle wasting disease muscular dystrophy (MD)
Twitter: @musclewarrior

Laughter and tears

Ruth Twitter pic

I’m delighted if not a little overwhelmed how #StopThePressure is going wild.

Just a little over two years ago it was a discussion with Lyn McIntyre about how could we help to improve the essential standards of nursing care. It really got going with a presentation to the then East of England PCTs Chief Executives on wanting to manage quality during the transition, debating the merits of yet another initiative to run up and down the country.

It’s been a fun journey

We’ve had so many laughs along the way and indeed tears too as we’ve learnt about data, bundles, collaboratives, procurement rules, definitions, grading, measurement… And much more.

The DVDs that staff teams made when they were involved in the learning collaborative were amazing… Simple and serious in their message about the pain of pressure ulcers as well as the prevention and SSKIN actions. There were some that were hilarious making me roar.

At one of the launches we had a quiz about pressure ulcers… Who could spot the grade four, was this a moisture lesion but there was a twist… A slice of Margarita pizza.. A few got it right but most graded it three. I’ve never been able to eat a margarita since.

The tears of frustration were there too, when some couldn’t see the importance of prevention of pressure ulcers. When some saw it as an unnecessary burden and criticism was personal. But through it all having the courage to do the right thing helped make us more determined to #StopThePressure.

There was also the time when Lyn nearly got a date. On a train to Birmingham, it was Safety Thermometer day, she had call after call, confirming it was 100% collection, yes it was today, yes this and no that.. After about the tenth call the guy across the table said. “Even I know what safety thermometer is!” The best chat up line ever was missed by Lyn.

And then there’s Twitter and how the student nurse conferences were born. A Twitter chat with Charlotte Johnston and within six months a conference in Lincoln with 450+ student nurses learning about #StopThePressure. Wow. And when the students presented the SSKIN for students well that was it…a few tears too. With pride.

There are now so many people involved and with their passion commitment and drive #StopThePressure will succeed and as a result the essential care we give patients will improve… From the bottom of my heart “thank you”.

 

Ruth May

Regional Chief Nurse, NHS England Midlands and East

 

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Let’s do it

MAxinePowerI have a special affinity right now for students training in healthcare professions. My daughter is a second year nursing student on clinical placement and calls me most evenings to chat about her day. Most days it’s after 9pm when we get to speak and she’s been on her feet since 7am. Some nights she’s so tired she can’t speak. Some nights she’s elated, some nights she’s sad. I’m constantly reminded when she’s speaking of my personal experiences of training as a healthcare professional. I trained as a speech and language therapist more than twenty years ago but some of her stories bring back vivid memories. Like the first patient that you form attachment with that dies,the first time you see someone the same age as you battling a terminal illness, the first time you encounter relatives that aren’t coping and the first time you are part of a medical error.

Healthcare professions training is a roller coaster of emotional responses which are so strong it’s impossible to ignore. Not only are we dealing with impossibly demanding physical work, technical skills and the emotional challenges of our patients and families,we are wrestling the most visceral responses of our own.  As we get more experienced we carry this forward with us into our professional practise. Here comes the rub – it’s how we learn to deal with these emotions that determines our future.

When we read stories of catastrophic failure in hospitals we repeatedly hear of problems with ‘culture’ and ‘leadership’. I wonder if also we are dealing with some individuals who have managed their response in the way that I was advised. ‘Develop a tough shell’, ‘protect yourself’ was what I was told ‘you can’t let it get to you’ was a favourite phrase of one of my less revered supervisors. Presumably, the extreme version of a tough exterior becomes an inability to feel and ultimately an inability to see. I wonder whether this is the beginning of a downward spiral, which attracts the like minded and becomes toxic with sufficient critical mass?

So, if not that, then what? What’s the way we develop ourselves as professionals, staying mentally and physically well. I wish I knew. My guess is that most of us find a way. My personal choice was exercise. The best senior nurses I know still cry – often. They choose to remain open and they have learned to be proud of their own vulnerability and channel their emotions into positive energy.

The fire burning in Lyn McIntyre and Ruth May is born out of years of frustration and a determination to do the right thing when every element of the system is conspiring against them. But even they need renewal and that renewal, ironically is coming from the energy of students. A new generation of healthcare professionals who refuse to accept the status quo and who are prepared to work towards a better healthcare system despite resistance and dealing with entering healthcare practice.

I am so proud of you all. Together we CAN eliminate pressure ulcers. Imagine if the students you train when you are supervisors  NEVER had to see a pressure ulcer because they simply didn’t exist. The future is imagined, planned and built. We need your help to build it.

Let’s do it.

 

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