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The Pressure Sore Alleviation Project
SOCIETY BUSINESS
The Pressure Sore Alleviation Project ressure ulcers remain a common and costly complication of the care received by many patients within both the NHS and the private sector. Epidemiological and economic data describing the impact of pressure ulcers are largely restricted to the acute care sector, and most attention with regard to improving the effectiveness and appropriateness of care has also focused upon hospital patients and their care. National guidelines related to pressure ulcer prevention now exist but there remains little guidance or help available to the private sector, in particular nursing homes, to enable these settings to adopt a systematic approach to the management of pressure ulcers. This project established in 1997 and so predating the recent NICE guidelines, was established by the Tissue Viability Society, with Section 64 funding from the Department of Health, to develop educational frameworks that would help foster a culture within nursing homes leading to the development of locally appropriate pressure ulcer guidelines. This Pressure Sore Alleviation Project (PSAP) was initially developed to assist nursing homes and hospitals collect pressure ulcer prevalence and incidence data so allowing national estimates for the scale of the problem in nursing homes to be determined. With this brief, the programme received Section 64 financial support in 1997. A pilot scheme was developed but it quickly became apparent that the ambitious objective was unrealistic given the plethora of approaches to data collection, local constraints on staff time and the difficulties inherent in comparing raw prevalence and incidence data. During the pilot stage it was evident from comments received from nursing home staff that additional education and formal support to enable the development of local pressure ulcer prevention guidelines would be welcomed. In response to these comments, the focus of the project shifted towards addressing these unmet needs, with agreement for this shift in emphasis received in 1998. To provide the knowledge base and relevant skills required by senior nursing home staff to develop appropriate pressure area care guidelines, a modular programme consisting of 10 separate units was developed. The ten learning units covered a range of topics ranging from the writing of guidelines through to specific aspects of tissue viability practice, as listed below: • Unit one: Writing guidelines and policies • Unit two: Data collection and record keeping
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© Tissue Viability Society JOURNAL OF TISSUE VIABILITY VOL 12 NO. 2 APRIL 2002
• Unit three: Pressure ulcer risk assessment • Unit four: Prevention of pressure ulcers -patient moving and handling • Unit five: Prevention of pressure ulcers - skin care; continence care and nutrition • Unit six: Prevention of pressure ulcers - equipment • Unit seven: Recognising pressure area damage • Unit eight: Wound healing • Unit nine: Wound dressings • Unit ten: Evaluation of PSAP. All of the learning units were supported by further reading lists that assisted participants to identify appropriate and relevant literature. Having completed all ten learning units, the module materials and reading lists constituted a substantial learning resource for dissemination within individual nursing homes. Each module was updated as new information and publications became available. Overall eight regional groups of nursing homes completed the formal training sessions; these were centred on Warrington (9 nursing homes), Portsmouth (25), Newcastle (13), York (8), Worcester (10), Bromsgrove (12), Enfield and Haringey (London) (12) and Norwich (10) with the number of participating nursing homes shown in brackets. Overall 99 nursing homes participated representing 3465 nursing home beds. The Portsmouth area contributed the greatest number of participating number of nursing homes, this in part resulted from a £1000 grant made available from the local education consortium to support the participation of nursing homes. While no evaluation of outcomes such as the number of policies developed as a direct consequence of attending the teaching sessions was undertaken, participants were invited to complete an evaluation form at the close of the final teaching session while verbal comments were elucidated after each training session. These evaluation comments were generally positive recognizing the need for the project and its successful implementation within each regional group. The anecdotal comments received would indicate that changes in practice did occur that would have been likely to have benefited the residents of the nursing homes. This project has successfully developed and implemented teaching material that has had a positive effect upon the skills and knowledge base of participating nursing home staff Access to the material should be broadened while there may be scope for a formal research· study investigating the impact of such teaching material upon changes in the occurrence and characteristics of pressure ulcers encountered in UK nursing homes.
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The Pressure Sore Alleviation Project ressure ulcers remain a common and costly complication of the care received by many patients within both the NHS and the private sector. Epidemiological and economic data describing the impact of pressure ulcers are largely restricted to the acute care sector, and most attention with regard to improving the effectiveness and appropriateness of care has also focused upon hospital patients and their care. National guidelines related to pressure ulcer prevention now exist but there remains little guidance or help available to the private sector, in particular nursing homes, to enable these settings to adopt a systematic approach to the management of pressure ulcers. This project established in 1997 and so predating the recent NICE guidelines, was established by the Tissue Viability Society, with Section 64 funding from the Department of Health, to develop educational frameworks that would help foster a culture within nursing homes leading to the development of locally appropriate pressure ulcer guidelines. This Pressure Sore Alleviation Project (PSAP) was initially developed to assist nursing homes and hospitals collect pressure ulcer prevalence and incidence data so allowing national estimates for the scale of the problem in nursing homes to be determined. With this brief, the programme received Section 64 financial support in 1997. A pilot scheme was developed but it quickly became apparent that the ambitious objective was unrealistic given the plethora of approaches to data collection, local constraints on staff time and the difficulties inherent in comparing raw prevalence and incidence data. During the pilot stage it was evident from comments received from nursing home staff that additional education and formal support to enable the development of local pressure ulcer prevention guidelines would be welcomed. In response to these comments, the focus of the project shifted towards addressing these unmet needs, with agreement for this shift in emphasis received in 1998. To provide the knowledge base and relevant skills required by senior nursing home staff to develop appropriate pressure area care guidelines, a modular programme consisting of 10 separate units was developed. The ten learning units covered a range of topics ranging from the writing of guidelines through to specific aspects of tissue viability practice, as listed below: • Unit one: Writing guidelines and policies • Unit two: Data collection and record keeping
P
© Tissue Viability Society JOURNAL OF TISSUE VIABILITY VOL 12 NO. 2 APRIL 2002
• Unit three: Pressure ulcer risk assessment • Unit four: Prevention of pressure ulcers -patient moving and handling • Unit five: Prevention of pressure ulcers - skin care; continence care and nutrition • Unit six: Prevention of pressure ulcers - equipment • Unit seven: Recognising pressure area damage • Unit eight: Wound healing • Unit nine: Wound dressings • Unit ten: Evaluation of PSAP. All of the learning units were supported by further reading lists that assisted participants to identify appropriate and relevant literature. Having completed all ten learning units, the module materials and reading lists constituted a substantial learning resource for dissemination within individual nursing homes. Each module was updated as new information and publications became available. Overall eight regional groups of nursing homes completed the formal training sessions; these were centred on Warrington (9 nursing homes), Portsmouth (25), Newcastle (13), York (8), Worcester (10), Bromsgrove (12), Enfield and Haringey (London) (12) and Norwich (10) with the number of participating nursing homes shown in brackets. Overall 99 nursing homes participated representing 3465 nursing home beds. The Portsmouth area contributed the greatest number of participating number of nursing homes, this in part resulted from a £1000 grant made available from the local education consortium to support the participation of nursing homes. While no evaluation of outcomes such as the number of policies developed as a direct consequence of attending the teaching sessions was undertaken, participants were invited to complete an evaluation form at the close of the final teaching session while verbal comments were elucidated after each training session. These evaluation comments were generally positive recognizing the need for the project and its successful implementation within each regional group. The anecdotal comments received would indicate that changes in practice did occur that would have been likely to have benefited the residents of the nursing homes. This project has successfully developed and implemented teaching material that has had a positive effect upon the skills and knowledge base of participating nursing home staff Access to the material should be broadened while there may be scope for a formal research· study investigating the impact of such teaching material upon changes in the occurrence and characteristics of pressure ulcers encountered in UK nursing homes.
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