Here we are at Eliminating Pressure Ulcer Breakthrough Series Collaborative, Learning Session 2. Ten teams have come together with a commitment to eliminate pressure ulcers for our patients both in hospital and in the community.
Associate Director of Quality Improvement, Katharine Goldthorpe, welcomes everyone to the Teams meeting.
This is the second learning session in the current Pressure Ulcer Collaborative.
Katharine introduces everyone within the Collaboration who are teams from: ED, CITU Wards 25, 35, 12 and C, The Arc, Lytham St Annes Community team Central West Community Team and Clifton Ward 1.
Katharine encourages the teams to think about more ideas to test from each other. There will be 5 minutes presentations from each area. She suggests the group think about new actions to test for the second action period.
Katharine hands over to Director Pete Murphy Director of Nursing, AHP and Quality who introduces his presentation entitled ‘Igniting Improvement’.
Pete welcomes everyone and thanks them for their fantastic work through first period of the collaborative and says that by keeping in touch we are starting to make some progress and hopes people are enjoying their learning.
Pete said: “The team are paying attention to an important aspect of care and are acting as vanguards leading the organisation whose work will stay for many years to come. The collaborative have already shown real commitment to reducing pressure ulcers. The enthusiasm, commitment and passion is clearly there. We are asking you to help us with tricky problems and you should be incredibly proud. The data is clearly showing things are getting better”.
“The data shows the start of a reduction of pressure ulcers in the acute setting. Over the last couple of months attendance has risen but the number of pressure ulcers remains low. We should be cautiously optimistic that the collaborative is driving change.”
The teams were shown a video telling the story of patients who have had pressure ulcers. We are that the generation of nurses and AHPs who can change these stories.
Pete Murphy then reminds the group that none of us should be accepting of the pressure sores for our patients, we wouldn’t accept them for our family members. Even though we talk about the data and charts, we should have in the back of our minds, the images that we have seen today.
Next comes the ‘Lightening Talks which are five minute presentations from each team.
First up is the Emergency Department team:
The team have implemented a care huddle in order to perform a skin assessment completed with 2 hours of patient arriving within ED. Standard Operating Procedure (SOP) is shared with all staff at handovers and in their FB group to update. They also have laminated copies of the information within each area. The Care Huddle started on August 1. It’s a good starting point and they continue to embed and set standards.
Next up are the ‘Ward 12 Warriors’:
Ward 12 implemented something similar to ED which is a skin assessment completed within one hour of admission. They created an audit tool to check what actions have been undertaken. They have implemented of a morning safety huddle to prevent delays in treatment. The change has resulted in an improvement. They have communicated improvement to all staff. They are researching if the temperature in the ward has an impact of moisture lesions.
Ward 25 are next to present. All their staff are on board to reduce pressure ulcers by 50% by November 2020. They hold regular ward meetings making all staff aware of targets. Study days have now resumed which will be repeated three times a year. Everyone has also signed a pledge to show their commitment. Every nurse on the ward owns information on each patient. They input data in chart which Matron checks regularly. The ward are fully committed to #EndPjParalysis to get patients moving and out of bed and joining in activities. The ward have had no pressure ulcers since start of the collaborative. (March 2020).
The ward’s aim is to reduce Cat 2 pressure ulcers by80% by November 2020. Introduced ‘Pause for Pressure’. Senior nurses and Ward Managers to assess patient skin within 60 minutes. They have made’ roles and responsibility’ posters. They are trailing a new rounding tool in October and are reviewing Ward Manager documentation. They are also embedding bay nursing and some HCAs are acting as a point of contact for pressure concerns. There has been a change in handovers. They have compiled a set of questions on walk arounds. They now have a Link Champion who works with dieticians. Ward C have had no hospital acquired pressure ulcers since the start of collaborations.
CITU have introduced a tissue viability daily review. Champions were writing in patients notes but are now also using stickers. They now have five TV champions and have increased. Huddles. The TV Champion is available once a day to explain what devices in place and to give advice. They have a monthly audit of skin and safety assessment tool. They have 100% compliance from safety huddle feedback. There are also displays for staff.
Ward 35 ‘The Ortho pod warriors’
The ward has an escalation process in place to get a Primo mattress within a four hour period. They have developed a form for every new patient and this has now been simplified. They introduced the documentation in July. More education and training is planned. They are also looking at the effect of ward temperature. There is a full team effort and everyone takes part.
Lytham St Annes – ‘Pressure Ulcer Busters’
Lytham district nurses aim to reduce pressure damage and improve communication to identify pressure sores. They have introduced a Pressure Ulcer Safety Cross to be filled in depending on different variables. They have introduced a Wednesday Safety Huddle for pressure ulcers. They are analysing if sores they moisture or cat 2? NQN are working with senior nurses who also provide clinical supervision. They are introducing medical photography and have TVN champions on board.
Technical issues mean that Clifton Ward 1 cannot join us at the moment.
Next we hear from Emma and Anna who are part of the QI Teaching Faculty.
They present the QSIR Virtual Programme. They are looking at Process Mapping and how that it can be part of the current improvement project now and in the future of Quality Improvement.
A couple of definitions are:
Process: A set of connected activities, material and/or information flow that transform a set of inputs into a defined output.
Process Map: A visual representation of a process, created by the people who operate and interact with the process.
Anna explains how mapping can help promote involvement and ownership and gives a visual representation of process with an opportunity to reflect. It looks at reality and avoids assumptions. The team practices process mapping with the example of making a cup of tea.
Clifton Ward 1 are now presenting the Lightening Talk:
The ward looked at staff engagement and made an ideas board for the staff who came up with numerous ideas. They looked at their Aerospace mattresses – they found a fault in 10 mattresses which have now been replaced. They realised that HCAs need more information in handovers. They have now printed handovers for HCAs with information on turns, catheter, continence etc. They also have had magnetic strips made to stick on board above the beds to indicate 2 or 4 hourly turns. New SAS chart hourly rounding.
The next Lightening Talk comes from the Central West Community Team ‘The Central West Pressure Cookers’
The team have been looking the social issues and pressures of their patients. Every time new patient referred health and wellbeing workers and nurse to work with their social concerns holistic as well as medical. Looked at postcodes and age categories of their area and are looking at a longer term change. Empowerment and social issues are a problem so are looking at supporting and engaging patients before ulcers occur. They are looking at the prevention element of their work.
Next up: The Arc ‘The Arc Angels’
ARC is a council run building with NHS staff. They team focused on SAS charts and ensuring council staff fully understood them. They have improved the process around documentation. |They have strengthened knowledge and understanding. They are continuing with SAS chart theme doing study groups gold standard SAS chart demonstrate what is and isn’t relevant on the chart. They are reviewing processes as they go along.
The teams are now ready to plan their PDSA cycles for the next action period. There are some fantastic ideas to test.
Katharine also advises how to keep on track for the next action period. There will be regular newsletters and the Qi team would like for the team to send in success stories. Everything is working towards the summit event on November 19, 2020, which is also Stop The Pressure Day. All leaders have been invited and is a great opportunity to show the great work that has been done.
Katharine closes with everyone putting on their cameras so that everyone can see each other and give each other a round of applause – What a great morning! Well done everyone.
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