Caroline Dowsett and Richard Shorney explain how the High Impact Actions save money in pressure ulcer prevention
The High Impact Actions for Nursing and Midwifery project sought best practice from the nursing and midwifery community that demonstrated a response to the quality and productivity challenge.
One of the actions focuses on prevention of pressure ulcers, which are estimated to cost the NHS £1.4-£2.1bn each year, approximately 4 per cent of total NHS expenditure. The Department of Health outlined an ambition to eliminate all avoidable pressure ulcers in NHS care and to significantly reduce the amount an average district general hospital spends on treating them, estimated at £600,000-£3m each year.
It may be assumed all healthcare professionals aim to provide care that meets the domains of quality (patient safety; experience and effectiveness) but the challenge is to identify the metrics and provide evidence.
Although much of what has been published recently addresses quality from a strategic perspective, it is important to make these models fit for purpose. How are these national ambitions and ideals from the DH transferred to everyday practice and who is accountable for delivering on the metrics of quality care?
The introduction of nurse-sensitive outcome indicators on a range of aspects of care aims to enable and motivate nurses to change their practice.
NHS Newham was the frontline submission for the high impact action “Your skin matters” and demonstrated a reduction in hospital admissions, improvements in the quality of care and savings above £59,100 over six months.
The tissue viability service at NHS Newham appointed a nurse to tackle the increased incidence of pressure ulcers in nursing home patients, many of which resulted in hospital admission. The incidence of pressure ulcers in nursing homes can be as high as 20 per cent. The service increased the number of patient review visits, provided education and training, and introduced a wound care formulary to support local nursing homes.
Over five months the tissue viability team demonstrated a 50 per cent reduction in admissions to the acute trust with pressure ulcers. They were also able to demonstrate a reduction in the severity of the pressure ulcers.
Calculating the returns on investment for this project showed that for every £1 NHS Newham invested in its tissue viability service it generated £51.56 of benefit over a year. This figure is based on direct costs of setting up the project, employment costs of a band 7 nurse, the cost of treating pressure ulcers, and the number of pressure ulcers prevented. The calculation does not take into account other quality benefits such as quality of life.
It is not uncommon to find patients with various forms of skin breakdown being treated by varied services. The effectiveness of the treatment, and management of the patient, often depends on which specialist practitioner the patient is referred to and may be governed by which service is available in their area. This can fragment care, with groups of patients being overlooked, and it highlights the need to develop integrated services.
Most pressure ulcers are avoidable in NHS care, yet many trusts are still experiencing higher than average incidence. Reducing this is a target that appears to be included in many quality schemes as pressure ulcer prevention remains a key indicator of the quality of care.
Tissue viability is a nurse-led specialty that does not always feature highly in trust strategy investment plans. Investment can lead to improvements in quality, reduced admissions and significant savings. It is important commissioners work with providers to commission high-quality care for all.
Caroline Dowsett is nurse consultant, tissue viability, NHS Newham. Richard Shorney is director, Real Healthcare Solutions.
High Impact Actions for Nursing and Midwifery is being led by the chief nurses from the 10 strategic health authorities in collaboration with the Department of Health, NHS Institute for Innovation and Improvement, The Royal College of Nursing, Royal College of Midwives and the Nursing and Midwifery Council. Eight high impact actions have been selected from 600 admissions that demonstrate improvements to quality of care, patient experience and a reduction in cost to the NHS.