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Are they
sitting comfortably?
Kate Goddard (centre) and some of her team who
devised a pressure damaage assesment chart with Heather Barden, Essence of Care
project leader (right). Pictured from left: Vanessa Pruce, Shobana O’Hara,
Hayley Peters, Elizabeth Baker and Sylvie Cox.
K ate Goddard and her
team in the Brighton main outpatient department have emerged as one of the
leading lights in tackling the first area of concern to be put under the
microscope in the trust’s Essence of Care programme.
The government initiative
aimed at getting the basics right and improving the patient experience set
benchmarks for eight areas of concern. These were identified from patient
complaints, Ombudsman reports and professional and patient feedback.
The trust started the process
in February when all areas assessed their pressure damage care, scoring it
against government documentation outlining best practice.
But Kate admits: "When I
first saw ‘pressure ulcers’ I thought ‘inpatients’ and I was sceptical.
Then I thought, hang on a minute, what about patients in wheelchairs?"
These patients in Outpatients
could be sitting in a chair or a wheelchair for more than a couple of hours,
waiting for a consultation and waiting to be picked up for an ambulance.
She knew, too, patients in the
trust are getting heavier. "We have something in the trust we call
barriatric patients, patients over 23 stone. They sit in wheelchairs that may
not be wide enough and not have the right back support and what they’re
sitting on may create pressure."
So, on reflection, she thought
that outpatients warranted careful attention in this area of concern.
What evolved was a
collaborative effort. She sat down with her trained nurses and talked about how
they would assess patients and decided to devise a pressure damage assessment
chart to use in the department.
Using a pressure sore
prevention document as a basis they looked at patients in a wheelchair to assess
their vulnerability.
There are a number of factors.
Weight and height, for example. Very thin people can be at risk as well very
heavy patients who could be sitting wedged in a wheelchair.
Incontinence could result in a
patient sitting in damp clothes, which would quickly affect the skin, some older
people have skin like tissue paper or may have broken spots, both constituting
high risks. Mobility, appetite, cardiac failure, peripheral vascular disease all
need to be taken into account as well as neurological deficits, major surgery
and medication.
The chart they devised scores
all these factors. Particularly high scores are awarded to patients in their
eighties, paraplegics or with tissue malnutrition, for example.
It is not possible to assess
every patient in a clinic. Some may have as many as 300 attending during the
day. So nurses seek out those in wheelchairs or very heavy patients or others
who visibly appear to be at risk.
The assessor decides how much
help they are likely to need, the equipment required (hoist, turntable rope
ladder, for example) and the manoeuvres that need to take place such as
transfers to bed or toilet.
They then make sure high-risk
patients get to the toilet during their stay and have drinks, even if it’s
water, and are given a patient information leaflet on pressure damage
prevention. Every hour they make sure the patient is comfortable in the chair,
has enough support for feet and back and that they actually move, standing up if
they are capable.
As part of the exercise,
nurses looked at the equipment available and found they had most that was
necessary apart from foam cushions. Kate is now purchasing pressure cushions to
use with patients at risk.
A company did an audit of all
the chairs to see if they were meeting the right standards and providing the
right support for backs and arms and seeing if they were washable.
The next topic in the
programme, in October, will be privacy and dignity.
"That will be our No.
1," Kate says.
That is an even bigger issue
in the department. Lack of soundproofing is a problem when, for example,
patients give histories during a consultation. Even worse is when they give
information when checking in at the desk.
"We’re ready
go," she says, "But it really gets down to funding!"
Two other big issues
highlighted by the recent benchmarking audit, says project leader Heather Barden,
were staff training and lack of patient information.
Mandatory training sessions
have now been organised across the trust by the wound care team for all nurses.
Patient leaflets are being designed and are also available through Coloplast.
"We have already made a
difference and I am proud to have been a part of it," Heather says.
She is now leaving to take up
a post at the Nuffield as practice development nurse.
Caroline Marsh, until recently ward manager on
Chichester at the Sussex County, is taking over from her and will be leading the
second benchmark on privacy and dignity.
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The Royal Sussex County Hospital, Brighton