EUROPEAN PRESSURE ULCER ADVISORY PANEL

Present:
George Cherry, Christine Cherry, Mike Clark, Sarah Daniels, Deborah Glover, Deborah Hofman, Cathy O’Neill, Hilary Scott, Barry Simmons, Steve Spurgin.

Meeting aim:
To bring together a group of individuals with different perspectives to discuss how to increase public awareness by the European pressure Ulcer Advisory Panel of the problem of pressure ulcers as a major health problem in UK.

The meeting started with a brief discussion outlining the objectives of the meeting led by George Cherry. It was decided that a major programme was needed to arouse public awareness of the problem of pressure ulcers and not simply publicity of the problem. Absence of the press at this meeting was good as a strategy needed to be put in place before issuing press releases. The underlying cause of pressure ulcers was thought to be due to ‘something gone wrong’, and because of this the potential for litigation has increased.

Following the opening discussion, Deborah Hofman presented several case studies demonstrating various types of pressure ulcers with different causes and stressing that the possession of pressure relieving devices used wrongly can be as dangerous as non use of pressure relieving equipment.

Generally the reporting of pressure ulcers as an adverse event is a local Trust decision. In reality not all patients realise that pressure ulcers are a result of poor care. There are agencies in place which could deal with pressure ulcer awareness by both the public and health carers, e.g., NICE (National Patient Safety Agency – Chairman Rory Shaw) with which the EPUAP should be liaising. With the changes in the NHS now is the time to lobby those who can help. Creation of inspections of units, new pathways to be followed. Strategy at the moment is very important. It was stated that people harmed within the health care sector are entitled to redress: i.e., examination of problem, apology, litigation and remuneration. Patients do not always understand the implications of litigation. It is important to get a lawyer who specialises in medical matters.

Information should be sought from local groups such as Age Concern, mentally and physically challenged persons, etc. Interest from senior management in the health service is a necessity.

The under-diagnosis and under reporting of pressure ulcers is a significant issue in the context of clinical governance and risk management. Some authors have stated that the prevalence rate for pressure ulcer in the hospitalised is thought to be 10% and mortality rates of those with pressure ulcers thought to be five times higher. Pressure ulcers do not figure highly as a cause of death of death certificates and thus the problem may be seriously underestimated. (Haider & Bennett). It is also thought that there is under-diagnosing and under-reporting of elder abuse and neglect.

The cost of treating pressure ulcers varies from £1080 (grade 1) to £15,000 (grade 4), and the total cost to the NHS annually is muted as being 5% of the total NHS expenditure. It was stressed that figures quoted should be in the context as to the extent of the problem and not in hard cost.

It was raised that nursing procedures in modern UK hospitals have changed with regard to the state of the patient. Twenty years ago the nurse had to report to the senior person in charge, the state of the patients health, any incidents which had happened during their shift and the status of the skin when the nurse left the shift. This is no longer practiced and in many cases there is no senior person to whom to make a report. Notes are written poorly and do not give an accurate picture of the status of the patient and the times of incidents recorded. Good note keeping should be a legal requirement but does not generally happen because the nurse or health carer do not like paperwork, do not like to admit to poor treatment or are just ignorant of the fact that the state of the patient should be documented.

Very few prevalence studies are carried out in hospital Trusts and even fewer which actually inspect the skin instead of just asking if there are any lesions. Large scale prevalence and incidence studies may show the trend of numbers of pressure ulcers but have no baseline with which to compare them. Individual hospitals or Trusts should carry out their own studies on a regular basis to check for deterioration or improvement. ‘League tables’ are not good as the data generally are not comparable.

Mike Clark presented the results of the UK portion of the EPUAP Prevalence study of pressure ulcers which was carried out last year. In the 15 UK hospitals taking part in this study there was a much higher figure (22%) for prevalence than previously thought (10%). It was stressed that patients were examined for this data. Oral reports without observation were not included.
Deborah Glover stated that there is a large amount of literature for health care workers regarding the prevention and care of pressure ulcers but very little for the patient and what is available is not always comprehensible.

Members of Industry, Health Workers and the Editor of the Journal of Woundcare,
at the first Publicity Meeting of the EPUAP.

In summary, the EPUAP meeting concentrated on UK data and how the data obtained from the prevalence study can be used to meet the part of the mission statement which deals with education of the public. Suggestions were made that all patients being admitted to nursing homes and hospitals should be given a handout warning of the dangers and consequences of pressure ulcers. Talks could be given to small local groups of people, e.g., SAGA; and CHI (the Commission for Health Improvement) could also be contacted for their help.

The way forward:
• What to do?
• Who to contact?
• Which communication channels?

Awareness of the size of the problem should be made through political lobbying, professional groups, and education of the public. The aim of the group is to bring prevalence figures down and to increase the quality of care both for prevention and the inevitable treatment of pressure ulcers.

We especially need to learn marketing skills from Industry and buy in help and ideas from other groups.

Attendees:
George Cherry Secretary/Treasurer EPUAP
Christine Cherry Administrator, EPUAP Business Office
Mike Clark Recorder, EPUAP
Sarah Daniels Medical Director, ConvaTec UK
Piers Forsyth Director, EMEA Marketing Wound Care
Deborah Glover Editor, Journal of Wound Care
Deborah Hofman Clinical Nurse Specialist
Cathy O’Neill Clinical Manager, Huntleigh Healthcare
Hilary Scott Programme Manager, Complaints and Negligence, Department of Health
Barry Simmons Group PR Manager, Huntleigh Healthcare
Steve Spurgin International Marketing Manager,\Wound Bed Preparation,Smith & Nephew

Another meeting of the group is planned in June 2003.