A national campaign is underway to get all DHB regions on board with a strategy to monitor and prevent painful, serious pressure injuries – particularly for the bedridden and people with spinal injuries – that cost the country an estimated $694m a year.
Each year an estimated 55,000 people get a pressure injury – that used to be known as bed sores or pressure ulcers – ranging from an early stage reddened patch over a pressure point, like a heel, to gaping wounds to the bone that people can die from.
District health boards are due to submit their first regular quarterly report on both hospital and non-hospital acquired pressure injuries this month to the Health Quality and Safety Commission in readiness for public reporting from next year.
The Commission, Ministry of Health and ACC have been working for several years towards a national strategy of monitoring and reducing harm from the preventable injuries (PIs). Pressure injuries are often regarded as a quality marker of care because the risk rises when care rationing, understaffing or lack of PI awareness results in patients not being regularly moved in bed or having their skin assessed.
ACC kickstarted its PI prevention campaign with Canterbury and West Coast District Health Boards last year, five more DHBs joined in early 2018 and in August the ACC board approved $6m over three years for its PI prevention strategy that includes bringing on board all public hospitals, residential aged care and community health care across the 20 DHB regions.
The PI risk is increased for people with decreased mobility and sensation. Recent ACC analysis that found about 20 per cent of its ‘serious injury’ clients – those whose injuries are so severe they require a lifelong relationship with ACC including serious spinal cord and brain damage – had had pressure injuries over a three-year period. The three year rate is even higher at 40 per cent (856) of ACC’s more than 2000 paraplegic/tetraplegic/spinal serious injury clients.
The wider Commission, Ministry and ACC focus also follows a major 2015 report by KPMG on reducing pressure injury harm that estimated 55,000 New Zealanders have a pressure injury each year at an estimated cost to the country of $694m. About 3000 of those will have a wound so serious that muscle, bone or tendon may be exposed that may require surgery to treat and repair the skin and tissue damage.
“Pressure injuries have a devastating impact, not only on patients, residents and their families but also on staff and the healthcare system as a whole,” says Dr Nick Kendall, ACC’s Treatment Safety Manager. “For some patients, pressure injuries can take months or even years to heal, causing pain, distress and major disruption to their lives and livelihoods.”
He said for ACC pressure injuries had been a hidden problem as health professionals in the sector tended to record or report the primary health issue or accident and pressure injuries were usually a secondary issue.
Health professionals have been encouraged in recent years to make treatment injury claims to ACC which has seen the claim rate rising from just over 1.5 per 10,000 DHB discharges in 2012-13 to about 3.25 in 2016-17.
From 2015 onwards the Commission has also called on health providers to report the more severe (stage 3 and 4) pressure injuries as serious adverse events which has seen the number of reports rise from less than 10 in 2012-13 to more than 50 in 2016-17.
Pressure Link Nurses
Kendall and ACC Senior Injury Prevention Specialist Sean Bridge visited Christchurch Hospital in early October to meet with two of the 52 Pressure Injury Prevention Link Nurses that Canterbury and West Coast DHB has recruited as part of the DHBs’ prevention strategy.
Susan Wood, a nurse and the Director of Quality and Patient Safety, Canterbury and West Coast DHBs, says the link nurse role is based on a UK concept of helping clinical nurse specialists build and develop the skills of a network of nurses in a specialty area, in this case pressure injuries. And in turn the link nurses can act as change agents in their own workplaces with an expectation they will drive some quality improvement programmes in their workplaces.
The new nurse role is part of the Canterbury Pressure Injury Prevention Community of Practice project that got underway with ACC support last year. The first cohort about to be trained include 18 from aged residential care facilities, about six from district nursing and eight on the West Coast.
Bridge said some other DHBs it is working with are developing similar roles, including Counties-Manukau DHB, but with different names like champions.
Wood said the data indicates that many more people are admitted to hospitals in Canterbury with existing pressure injuries rather than develop them while in hospital. “While we need to prevent pressure injuries in our hospitals, we are also focusing on community prevention and raising awareness of the risk factors and management strategies to prevent pressure injuries in the community and all health care facilities.”
The SSKIN bundle recommendations to reduce risk and impact of pressure injuries include:
- Surface – provide a supportive and pressure-relieving surface (mattress)
- Skin inspection – undertake regular checks for discolouration and pain on bony areas (such as hips and heels) and under or around medical devices
- Keep moving – change position often
- Incontinence – keep skin dry and clean
- Nutrition – eat healthily and drink plenty of fluids.
ACC pressure injury strategy:
- Implement the Guiding Principles for Pressure Injury Prevention and Management in New Zealand across the whole population served by each DHB , including aged care and the community.
- Develop and publish evidenced-informed consensus for the treatment of pressure injuries with a focus on severe pressure injuries.
- Improve education and skills across the health workforce to support the prevention and management treatment of pressure injuries.
- Share information on how to prevent pressure injuries to people at risk from people with similar health conditions or injuries