Under pressure – how we’re reducing pressure ulcers in our hospitals

Pressure ulcers can be a serious problem for patients who cannot move easily or are wearing medical devices. In this blog post, Sue Burgis, head of practice and innovation in the nursing directorate at Imperial College Healthcare NHS Trust, talks about how staff at the Trust are implementing a combination of large-scale innovations and smaller day-to-day changes that helped us reduce pressure damage amongst our patients by more than a third last year.

A pressure ulcer, or pressure damage, happens when an area of skin and deeper layers of tissue are damaged by pressure or friction. This is often caused by poor circulation. You can develop a pressure ulcer in a very short period of time if you’re already ill, whether that’s at home or once you arrive on the ward. Either way, anyone suffering from pressure damage will experience pain and potentially need a longer hospital stay because of it. If a pressure ulcer worsens it can lead to complications that can become dangerous if not treated, which is why it is a serious on-going issue in hospitals. Pressure ulcers are also an indicator of quality of care, so there is a real need for us to do everything we can to prevent patients developing them. That is why we’ve decided we need to come up with as many ways as possible to address this challenge.

We managed to reduce incidences of pressure ulcers by 37 per cent since last year. But we are on a constant journey towards our ultimate target of zero incidences of hospital-acquired pressure damage, so we’re always trying to come up with better ways of helping our staff to ensure the best possible care to help achieve this goal.

Pressure ulcers can affect just about anyone, but some patients are particularly vulnerable: patients who are elderly or suffering from a number of different health issues, such as heart problems and diabetes, are more likely to develop a pressure ulcer. We also get a lot of people coming in who already have pressure damage, so we have a big responsibility to make sure we help these patients in particular. We need to do everything we can to ensure we reposition and move patients regularly, and we’ve discovered there are more things we can do to support staff to reduce the incidence of pressure ulcers all over our hospitals.

Specialised care plans

We have a hard-working team of nurses who specialise in tissue viability, which is anything affecting skin and soft tissue including surgical wounds and pressure ulcers. Through referrals from ward staff, they provide advice all over the Trust and help design the right care plan for different cases of pressure damage.

Better medical device design

One of the things we struggle with at the moment is what we refer to as ‘device-related pressure damage’. A lot of our patients will wear any number of medical devices during their hospital stay, for example anti-embolic stockings, oxygen masks and catheters. Any of these can cause a pressure ulcer and so it is vital that our staff regularly inspect patients’ skin around these devices. One way we’re tackling this is by working with the Helix Design Centre, which is a team of clinicians and designers that makes design-led improvements to healthcare at the Trust. Together we’re developing a device to reduce pressure from the elastic that sits behind your ears when you have an oxygen mask on.

Monitoring data across the Trust

It’s important staff have easy access to data about pressure damage to help them manage risks locally. We have developed an app which allows staff to report incidents of pressure damage, and then view this data at ward level to see how they’re doing in terms of trends and numbers. They can also download the information behind it to have a look in detail at what that pressure damage was and use this to identify specific areas of improvement. We rolled this out 18 months ago and the app has been shortlisted for a Nursing Times award.

Working with patients and our community

It is key that we engage with the community to prevent pressure ulcers. A lot of our patients come to us with pressure damage already – it can be difficult for carers at home who often don’t have the resources to move patients around. To help vulnerable people and those who care for them, a professor of nursing from Buckinghamshire New University has designed an app to help, in partnership with our local commissioners. The app, which we are helping to promote, can be downloaded onto your phone and tells you who is at risk of pressure ulcers and how best to prevent them. We’re also trying to help patients with information leaflets, and with advice from allied health professionals, such as dieticians, because things like diet and nutrition are important too.

Managing pressure damage is about making all of these responses ‘business as usual’ – helping staff to focus on prevention even when we’re at our busiest. We’ve already had a lot of success by taking every opportunity to make improvements – it’s essential that we all work together now towards our goal of zero incidences of hospital-acquired pressure damage.

Learn more about pressure ulcers on NHS Choices. 

Learn more about the PUInfo App designed by Buckinghamshire New University.