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Nurse-led initiatives transforming patient care across the East Midlands

Nursing Standard’s series celebrating modern nursing roles in the UK continues with a focus on three nurses in the East Midlands who are achieving outstanding results in managing asthma, reducing falls in hospital, and tracking pressure ulcer incidence.  
Geraldine_Edwards_Joanne_Lewis-Hodgkinson_71.jpeg

Nursing Standards series celebrating modern nursing roles in the UK continues with a focus on three nurses in the East Midlands who are achieving outstanding results in managing asthma, reducing falls in hospital, and tracking pressure ulcer incidence

Good nursing is, of course, about delivering good care to individual patients, but its about so much more, says RCN East Midlands regional director Sheila Marriott. As these examples show, nurses are applying their experience, expertise and passion to spearhead systemic changes to benefit whole groups of vulnerable patients.

Sonia Greenwood is lead asthma clinical nurse specialist at Derby Teaching Hospitals NHS Foundation Trust. She was recently awarded trust employee of the year for her outstanding work with asthma patients, and this month launched a ground-breaking community asthma service.

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Nursing Standard’s series celebrating modern nursing roles in the UK continues with a focus on three nurses in the East Midlands who are achieving outstanding results in managing asthma, reducing falls in hospital, and tracking pressure ulcer incidence

‘Good nursing is, of course, about delivering good care to individual patients, but it’s about so much more,’ says RCN East Midlands regional director Sheila Marriott. ‘As these examples show, nurses are applying their experience, expertise and passion to spearhead systemic changes to benefit whole groups of vulnerable patients.’ 


Sonia Greenwood is lead asthma clinical nurse specialist at Derby Teaching Hospitals NHS Foundation Trust. She was recently awarded trust employee of the year for her outstanding work with asthma patients, and this month launched a ground-breaking community asthma service. 


Deepak Subramanian and Sonia Greenwood developed a model for asthma care.

‘When you get the treatment right with asthma, you can make a huge difference to people’s lives. When patients understand their asthma and their treatment, they become empowered and start to take control of their health. 

‘I deal with patients with a wide range of asthma severity. I have helped reduce hospital admissions by making sure every patient admitted has a personalised asthma management plan. According to Asthma UK, this makes admissions with an exacerbation four times less likely. 

‘I always go the extra mile, but getting this project up and running has been my best achievement so far.’

Sonia Greenwood

‘Some of the patients are referred to my nurse-led clinic by GPs, others have been admitted to hospital. Many have a combination of severe asthma, complex comorbidities and/or challenging social backgrounds, and I realised the importance of spending a lot of time building a relationship with these patients and their families. 

More support 

‘My patients place a lot of trust in me and will often contact me out of hours. I’m happy for them to do this as it gives them the confidence to manage their condition. One patient wrote me a thank you letter saying I’d allowed them to regain their independence and go back to work, which made me proud of the service.

‘I am fortunate to work with a like-minded respiratory consultant who shares my passion for asthma. Dr Subramanian and I have developed a model for asthma care over the past two years, and were recently successful in getting funding from NHS England for a novel pilot project. 

‘The IMPACT (IMProving Asthma Care Together) project, which launched earlier this month, comprises four specialist asthma nurses who will go out into the community to educate health professionals and support patients. The seven-day service will provide 48-hour follow-up clinics for patients who are admitted, and support those having an exacerbation. 

‘Setting up the team has been an enormous challenge, but the patients want this. They want more support and for health professionals to understand asthma. I always go the extra mile, but getting this project up and running has been my best achievement so far.’ 


Joanne Lewis-Hodgkinson, falls lead nurse at Sherwood Forest Hospitals NHS Foundation Trust, has reduced the number of falls at the trust by 30%.


Geraldine Edwards and Joanne Lewis-Hodgkinson
with the falls box.

‘When I was a ward sister on a care of the elderly ward there were a number of falls, and I decided it was something I wanted to address. In 2000, I applied for a secondment with the falls lead nurse, and was appointed full-time last year. 

‘Our falls box, initiated by my predecessor Geraldine Edwards, has been a great success. Every ward has a red box with a ‘falling man’ sticker containing a lifting blanket, a pen torch for neurological observations, gloves, swabs, socks and a post-fall proforma form. This ensures all falls are dealt with effectively and recorded. 

‘I have tried to address all the practical causes of falls. We put ‘falling man’ signs above the beds of at-risk patients, a notice about patients who should not be left unattended in the toilet, and a sticker is added to medical notes that will be seen on any readmission. Falls are also discussed at every handover. 

‘What gives me job satisfaction is engaging staff, maintaining patient safety and getting results.’ 

Joanne Lewis-Hodgkinson

‘We applied for charitable funds for double grip socks and slippers, and outsized grip socks to prevent patients with foot bandages from slipping. We’re trialling non-slip chair and floor pads, are looking to replace pedal bins with sensor bins, and have changed the position of toilet roll holders throughout the trust so that patients don’t have to lean back. 

Engaging staff 

‘I provide educational programmes at varying levels, including inductions for new staff, annual updates and regular study sessions, and also train medical students in falls prevention. For staff who find it difficult to come to meetings, I developed Front Line Falls: every week I take information about falls to a different ward and all staff, patients and visitors can attend. 

‘I also analyse the location and time of all falls every month. If there are a number of falls on a particular ward, I meet with staff to see what education is needed and talk to every patient who had a fall. 

‘Staff engagement is vital. Staff members have been proactive and I always ask for their ideas. Every ward has a falls champion and every month a ward is presented with a certificate. 

‘In August 2015 we had 160 falls. In July 2016 there were only 82 – almost half. What gives me job satisfaction is engaging staff, maintaining patient safety and getting results.’ 


Mark Collier is nurse consultant, tissue viability, at United Lincolnshire Hospital NHS Trust. With help from IT staff, he developed a pressure ulcer notification tool (PUNT) which allows clinical staff to report and review reliable pressure ulcer data.


Mark Collier created the pressure ulcer notification tool.

‘When I came to Lincolnshire in 2002, I was the only tissue viability nurse working across six rurally-based hospitals. 

‘Unless you know the extent of a problem you cannot demonstrate improvement. What drove me to develop this tool was a desire to report accurately the pressure ulcer incidence within each hospital and across the trust as a whole. I wanted to be able to record a patient’s skin state on admission and to record, monitor and track any hospital-acquired pressure ulcer. 

‘Throughout my career, my aim has been to make connections between theory and practice. PUNT does just that.’ 

Mark Collier

‘PUNT is easy to use. We have an e-learning programme that takes about 20 minutes to complete, and PUNT can be used at any ULHT hospital and in any clinical setting. 

‘The fact that each ward can look at their data and see progress at any time really helped to build confidence in the system. 

‘At an initial assessment we record all the relevant clinical and patient details, a detailed description of pressure ulcer history and ‘at risk’ scores, which can be regularly updated. So when a patient record is assessed, their ulcer history will appear as an alert, enabling practitioners to identify potential ‘at risk’ areas. 

Clearer understanding 

‘PUNT has also helped to improve patient care more generally: there is better skin assessment, a clearer understanding of personal care needs, and as we have a record of where patients were admitted from, we can identify potential ‘hot spots’, or homes that need further support.

‘The incidence of pressure ulcers for all hospital admissions is 0.5%, down from a peak of 6% since PUNT was introduced. Hospital-acquired heel pressure ulcers have gone down by more than 30% since 2011. Our current rate for category 3 and 4 is 0.35% and for category 1 and 2 about 8%.   

‘Further improvements are also being developed. One will allow clinical photographs of pressure ulcers to be recorded on admission and discharge and uploaded alongside the pressure ulcer record. We hope to develop a wireless form so that district nurses and other trusts can use it. 

‘Throughout my career, my aim has been to make connections between theory and practice and PUNT does just that. I get great satisfaction when I see ‘at risk’ patients who do not develop pressure ulcers and go home well, with their skin intact.’ 


Alison Whyte is a freelance journalist 

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