PRESSURE ULCERS, DO WE NEED A RE-THINK?

“Is a rethink required around the strategies to prevent PUs or are the PUs we are now seeing due to the advancing age, severity of illness and number of co-morbidities patients in our care are experiencing? Read the latest blog from Joanna Swan, Senior lecturer in Tissue Viability, Birmingham City University and TVS Trustee

Pressure ulcers (PUs) continue to cause concern amongst Healthcare Professionals. We know the high cost to the NHS and the cost to the individuals that are living with them but the PU problem just doesn’t seem to be going away. Reductions in numbers and severity have been made, yet it feels as though we’ve come to an impasse. Is a rethink required around the strategies to prevent PUs or are the PUs we are now seeing due to the advancing age, severity of illness and number of co-morbidities patients in our care are experiencing? Personally, I think it’s both.

Is there a knowledge gap?

I recently read a study published in the TVS journal, “Nurses’ knowledge and practice of pressure ulcer prevention and treatment: An observational study. Saleh et al. (2019) Journal of Tissue Viability 28(4), pp.210-217.” This study examined nurses’ knowledge of PU prevention and observed how often PU preventative actions were taken. There were a number of findings but two of these really piqued my interest.

Firstly, where a risk assessment score (RAS) had been used, there was a higher implementation of preventative strategies. This may sound obvious but there has been a lot of debate recently about how useful, or not, RAS are. I would argue that a RAS can guide the strategies to mitigate risk, however a RAS is only useful if completed accurately and acted upon.

Secondly, that higher education was significant for implementing treatment for existing PUs but not significant for prevention. It is unclear whether additional training regarding PU prevention had been undertaken. This was a Jordanian study and may not be transferable however, the findings resonate. The results reflect a reactive rather than proactive approach which is something that I and TVNs from other areas have noted in practice. Other studies have found that well-educated nurses with additional PU training had more awareness of preventative strategies, however did they implement them?

There are so many resources and educational platforms available to healthcare practitioners regarding PU prevention and trusts often have in-house education programmes/study days available but are people using them? Is there a problem with level of knowledge, is there a problem in consistently implementing preventative strategies or, maybe, there’s a documentation issue?

So, have we plateaued in terms of our PU numbers? We may have for now, but implementation of consistent preventative actions remains a challenge. There are so many possible reasons for this, not excluding the workforce problems the NHS is currently experiencing. However, there appears to be a continuing problem putting knowledge into practice. I believe this is the nut to crack. There are solutions out there, the challenge is to find them.

This blog was first written in February 2020……and then there was COVID!

COVID has brought a number of further challenges. Anyone that managed to attend the “biomechanics of PU development and the worrying links with COVID-19” session by Amit Gefen at EWMA/TVS 2020 will have seen an explanation as to why COVID is an additional risk factor for PU development. This is related to an increased inflammatory response and an increased tendency for clotting. Many of you will, therefore, have seen a distressing increase in your PU numbers. I believe these will reduce and plateau out again but what will we have learned in terms of prevention during this awful time of COVID that we can put to good use as we move forward?

I stand by the first version of this blog, PU prevention is about putting knowledge into practice and if COVID has taught us anything we can adapt, we learn quickly and we rise to a challenge.

One comment

  1. I agree with the Jordanian study but I don’t think we’ve plateaued.in terms of More focus is needed on pre registration education, making training post Qual mandatory like Resus . We should also be targeting those most likely to have the greatest impact on prevention , the patient and formal and informal carers . Many Care agencies simply aren’t educating their staff about PU prevention- this has to be tackled head on . Those commissioning these companies need assurances that their staff are trained to an acceptable standard.

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