Lightbulb innovation: early warning system for pressure ulcers

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District nurse Carol Gill isn’t afraid to challenge poor care. Following a local incident when patients in a unit for older people with mental health problems developed severe pressure ulcers without nurses being alerted, she felt driven to develop an early warning system.

Establishing need

She used the findings of a subsequent investigation to inform her thinking and set about improving knowledge of pressure ulcer recognition among staff in care homes across Bradford.  

What Carol found was startling. Although care delivery in residential homes is predominantly delegated to health care assistants (HCAs), research showed little or no evidence of HCAs recording pressure ulcer damage. In some care homes HCAs were not even allowed to write in notes. Carol believes this, combined with a lack of training in recognising early signs of pressure ulcers, resulted in care home staff not always reporting problems until significant damage had been done and more NHS cash was required to treat patients.

‘It’s common sense,’ says Carol. ‘If we know about pressure ulcers developing we can address the problem before it gets worse. I’ve worked as an HCA myself so know how valuable the role is. When given the tools and time to develop, the potential for HCAs to enhance patient care is huge. It’s about nurses and HCAs working together to make change happen.’

Evaluating impact

With support from her trust, Carol was funded to conduct a pilot in six care homes. She delivered training and educational sessions, and encouraged health care staff to use a reporting and recording tool she had developed – a ‘traffic light’ pathway that identified HCAs’ responsibilities in recognising and escalating concerns.

Building on success

Over the course of 12 months, the care homes saw a reduction in pressure ulcers by an average 25 per cent. Carol says: ‘This is such a simple model but has huge potential for being replicated. It costs the NHS £2.4 billion each year to deal with pressure ulcers but the human cost is incalculable. Given that 85 per cent of pressure ulcers are preventable the solution seems easy to me.’

Further information

Carol's work was runner-up of the inaugural RCN Frontline First Innovations award 2011.

The Office for Public Management have used Carol's work as a case study to demonstrate return on investment. How supporting Health Care Assistants to manage pressure sores can save up to £90,000 per annum, reduce prevalence of pressure ulcers and improve quality of life for patients (PDF, 68KB)

If you'd like to know more about this innovation, please contact Carol Gill, email: carol.gill@bradford.nhs.uk.

 

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