Sore need for data that will relieve the pressure

Remember Florence Nightingale’s famous maxim: ‘It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm’.

She would turn in her grave were she to read the 1993 Touche Ross report on pressure sores. Its conclusion that, ‘The cost of prevention may be more expensive than the cost of treatment’ sits uncomfortably alongside the report’s photographs of grade-4 sores.

Enough demonstration projects have shown beyond doubt that pressure sores are completely preventable. Zero or near zero levels have been achieved in a variety of settings. If you don’t believe it, then your trust’s efforts to locate models of best practice have been woefully inadequate.

If you actually know how your trust performs on this key indicator, you will be one of a small minority. A few might be able to report results from periodically conducted prevalence studies which indicate how many patients are suffering from a pressure sore on a designated day.

But such data is of little real value as it fails to identify where the sore originated - so the buck is passed between hospital and community, with the patient sitting uncomfortably as piggy in the middle.

These are worthless surveillance systems. Only reporting the incidence of sores will supply the hard facts needed to help shape an effective preventive policy which embraces - among other things - proper risk assessment, adequate staff training, agreed protocols, and an appropriate mix of pressure- relieving equipment.

This year’s study by Birmingham University’s health services management centre for the NHS Confederation reveals that circulation of the 1995 Effective Health Care bulletin on this topic has had little impact.

Depressingly, the Don’t Knows constituted the dominant response to five of the six questions asked of trusts. This suggests the issue hasn’t yet received the serious attention it deserves.

Every trust should be required to collect pressure sore incidence data and report the results to its board and/or the new National Institute for Clinical Excellence. This would be compatible with the government’s agenda, which surely has to align with Florence Nightingale’s ‘no harm’ stricture.