EUROPEAN PRESSURE ULCER ADVISORY PANEL

BARTS AND THE ROYAL LONDON TISSUE VIABILITY WEBSITE. AN OPPORTUNITY FOR OFFERING ON-LINE EDUCATIONAL EXPERIENCES FOR TRUST STAFF

Ramona Buchan
Barts and the Royal London Hospital, London, UK

Introduction

Our aim in Tissue Viability was to launch a hospital website, which goes beyond providing information about our service. I saw it as an educational opportunity to provide information on aspects of wound care and equipment usage in pressure damage prevention. The information is updated with new articles and information on a monthly basis.

Brief content

The home page contains a Tissue Viability 'staff profile' together with basic information including service philosophy, annual reports, and audits findings. There is a 'product focus' section where we look at a particular wound care product, and we also include the results of recent research. We also focus on a particular type of wound i.e., the diabetic foot. This information is updated on a monthly basis. Recently we have just added an article on mattress testing procedures.

We have a section on the link nurses complete with their names and contact numbers. We plan to commence link nurse web page interviews, so that the link nurses can have the opportunity of sharing with others about how they fulfil their roles and any good ideas they may have.

The information is presented with good use of visual displays etc., and is kept fairly lively and interesting. All wards and most departments now have access to computers, and many areas now produce all their careplans on the computers, so it is fairly easy for staff to access this information. We are in the process of designing an interactive chat page. This will enable staff to ask any questions regarding tissue viability and for us to share our answers with all that are interested. We do plan to research peoples opinions of the web pages usefulness as an educational resource in the future once it is more established as it is still very much in its infancy stage.

HOW TO IMPROVE THE QUALITY OF CARE TO PATIENTS AT RISK OF DEVELOPING OR ALREADY SUFFERING FROM PRESSURE SORES.

Agnes Jacquerye
Quality Adviser, Erasmus Hospital, Free University of Brussels, Brusells

Introduction

Measuring the quality of care is essential to know the extent of a problem. A regular measurement of the quality of care helps monitor its development and its improvement. However, simply measuring and fixing objectives and then quietly waiting cannot achieve any real improvements. Quality improvement still is a real challenge to take up. The Belgian pilot study illustrates this problem as far as pressure sores are concerned and tries to find solutions.

Methodology

The Belgian Ministry of social Affairs, Public Health and the Environment gave its support to five pilot studies on the prevention of pressure sores. These national audits were coordinated in 1995, 1996, 1997, 1998 and 2000 by the Free University of Brussels, Erasmus Hospital, the Katholiek University of Leuven, and by a national working group. The five national audits were each carried out one day per year. These measurements concerned resources (seven indicators), the process of care (five indicators), and outcomes (five indicators). More than 200 health institutions participated on a voluntary basis, and around 30,000 patients were included in the study.

Results

The results showed a significant improvement from 1995 to 1996, and from 1996 to 1997. This could be explained by the fact that measuring was starting, and by the fact that an awareness environment and action plans were being implemented. On the contrary, the results were less convincing between 1998 and 2000. For example, the pressure sores developed in the care units represented 57% of the existing pressures sores in 1995, then 55% in 1996, 51% in 1997, 52% in 1998, and finally 50% in 2000. The stagnation of these results shows the difficulty faced when trying to implement lasting change oriented towards improvement.

Piloting change requires serious thought on the 'know how' necessary to transform a project in a motivating and operationally viable way. To accomplish this, Jacquerye (1999) suggests taking into account the VIP model. The VIP model has two components: the first is to consider everyone as Very Important. The second consists in taking the following three elements into account: values, interest and pleasure. This is because the project has to be in concordance with the values accepted by others (Values), to bring specific interest to others (Interest) and give rise to Pleasure.

To make the model operational the author also suggests an agreement on the upholding and the improvement of quality. The aim of this agreement is to bring together the targeted action plans and the means commonly negotiated by care unit executives and staff on the field. This agreement leads to a dynamic environment based on confidence and is one of the keys of change. Health institutions have applied these two models with success.

Summary

Measuring quality of care in the area of pressure sores gives a snapshot of the situation and the extent of this public health problem. Improving the quality of care still stays a challenge to take up. The five Belgian and national audits (1995, 1996, 1997, 1998 and 2000) carried out in more than ten thousand care units, and involving, on a voluntary basis, more than 200 health institutions, brings this problem to the fore.

The VIP model (Value, Interest and Pleasure) is suggested to help bring about change. To be operational, this model is combined with an agreement of confidence between executive and staff personnel showing the responsibilities of each, the plan of actions decided, the means needed and the recognition of the work done.

THE DIFFICULT WAY TO A QUALITY MARK: LINKING PATIENT CHARACTERISTICS TO PRODUCT PROPERTIES

Ronald Boumans, Rom Perenboom, JeUe Gerritse and M.J. Lubbers

Introduction

The Dutch Health Insurance Council (CVZ) would like to rationalise the way support surfaces are being prescribed. Just like in medicine prescription patient characteristics should generate a clear indication for the choice of intervention. CVZ asked TNO Prevention and Health to do a first step towards this goal by defining relevant patient characteristics, matching product properties and methods for measuring these. These results could be an essential basis for developing a quality mark. This could be developed by follow-up projects after this project.

Methods

Literature search has been done into the aetiology of pressure ulcers, systems of describing patient characteristics and prevention protocols. This search has been supplemented by expert interviews and panel discussions with experts. Evaluation by experiments was not included.

Results and conclusions
Some conclusions:

• Tissue distortion during time is in the cause and prevention of pressure ulcers much more important than interface pressure-
• It might be necessary to use different definitions for damage to weak tissue in order to distinguish pressure ulcers from other skin damage. This is necessary for prescribing the right prevention or treatment.
• Beds don't cure pressure ulcers. However, if a patient has a pressure ulcer the chances of developing more ulcers may have significantly increased. Patients with ulcers should therefore, in most cases, be put on systems meant for people with a higher risk.

Beds or mattresses are split up in three main groups: non/low risk surfaces, medium risk surfaces, and high risk surfaces. The right level for an individual patient is selected by looking at the general risk, the presence of ulcers and other relevant factors. A distinction is made between factors and indicators. Factors have a causal relation in the development of pressure ulcers with regards to the support surface. Indicators help to predict a risk, but don't necessarily have anything to do with the aetiology For example, if it is impossible to turn a patient, this fact alone could be a reason to select an other product category. The mental state is an example of an indicator.

The product categories have different relevant product properties. Within the categories it is possible to look at specific properties that are linked to specific factors. For example, if it is not possible to turn a patient the support surface should compensate in such a way that tissue deformation during time is kept within certain limits.