Root and branch pressure ulcer project proves its worth

It is said that implementation is the mark of successful research. William Gage’s article, Preventing pressure ulcers in patients in intensive care, is a good example of the difference a well thought-out project can make.

The article was published as part of Nursing Standard’s tissue viability supplement in the February 25 2015 issue. It will be discussed online in the Journal Club on Friday March 6 2015 at 12.30pm. Please join in using the hashtag #NurseJC if you can.

One of the best features of the project was how grounded it was. Staff, and importantly, clinical managers from four intensive care units (ICUs), all bought in. A formal method to ensure high standards in Imperial College Healthcare NHS Trust was already in place, and this was used to plan, carry out, implement and evaluate the interventions. Root cause analyses helped explain why ulcers occurred.

Also impressive were the quality and amount of data collected. Cumulative monthly data are available on avoidable harms, including pressure ulcers, for all of England and for trusts. The NHS Safety Thermometer is a new resource for me, but it is plain to see its value. These data and individual reports from the ICUs meant the project team could assess progress easily.

Pressure ulcers are a thorny issue – painful, distressing and dangerous, particularly in ICU. As Gage reports, older people in ICU with pressure ulcers are two to four times more likely to die than those without. The frustration is that ulcers should be preventable, yet they still continue to harm and contribute to the early deaths of vulnerable people.

There is no single cause for pressure ulcers, so a uniform approach was not appropriate. Instead, a care bundle approach was taken, which was developed into a set of essential standards that included not only direct nursing care, but also all documentation. The target compliance with the standards was set at 90%, and this was checked weekly. If a unit failed to reach the target, a remedial action plan was needed.

The pilot data, gathered between February and November 2014 and reported in Gage’s paper, showed a steady decrease in critical care-acquired pressure ulcers. Gage says this trend continues and adds that dissemination of the essential standards is occurring throughout the trust. It is a great example of a root and branch approach starting to flower.

About the author

Ed Rowe trained at St Mary’s Hospital in Paddington, London, in the late 1980s and practised in general surgery. He now works on the Nursing Standard’s art & science desk as a clinical editor. He blogs in a personal capacity about the NHS and health-related issues. Follow Ed on Twitter: @edrowe0