Agenda item

To provide assurance of pressure ulcer prevention and prevention of chronic wounds strategy.

Rose Baker and Katey White were in attendance at the meeting to present an update report and provide assurance of pressure ulcer prevention and prevention of chronic wounds strategy.

Rose Baker confirmed that pressure ulcers and tissue viability relates to bed sores. She indicated that there have been challenges and a rise in incidents in May 2015 as detailed in the report and advised that this was considered to be related to the climate change in May. The report considered the reasons for the increases and the actions that had been taken to address issues including the development of a Tissue Viability Strategy (TVS) which was under consultation with CCG, Public Health (PH) and other relevant leaders.

She advised that a tendering process had commenced for the community equipment service the contract which was expected to commence in July 2016. She    highlighted that the hospital had invested in ‘ToTo’ patient turning equipment which provides regular tilt or turn movement of the bed mattress to help prevent pressure ulcers and re-assured the panel that patients were not disturbed by the movement and that with the ToTo they did not require a physical turn to relieve pressure.

Councillor Stephen Simkins welcomed the feedback on results and asked for more detail about inherited incidents.  Rose Baker clarified that inherited incidents relate to pressure ulcers acquired outside the hospital.

Cllr Stephen Simkins asked if more could be done by carers to prevent pressure sores developing in the patient’s home to save costs to community nursing teams or hospitals should the pressure ulcer worsen. He suggested that the commissioning process could include something relating to training about pressure ulcers for carers in the specifications.

Cllr Sandra Samuels, Cabinet Member for Health and Well Being, advised that if the patient care is complex the patient may be stationary for long periods of time; she advised that pressure sores can be formed in as little as four hours and that patients need to be moved either by turning or tilting.

Cllr Stephen Simkins suggested that prevention should be increased through training and awareness sessions for carers working in the community and that there should be a discussion with CCG and consideration of some invest to save initiatives. Cllr O’Neill enquired about the advice provided to carers of bedridden patients; Cllr Harbans Bagri highlighted the need for care providers to receive monitoring and feedback from the carers of elderly people.  

Rose Baker indicated that training is provided for carers, leaflets are provided relating to what they need, but she welcomed any additional mechanisms to raise awareness with carers in the community to help with the prevention of pressure sores. Cllr Sandra Samuels, Cabinet Member advised that there are replacement mattresses available for those individuals who are prone to pressure sores. Katey White clarified that there were different grades of pressure sore and provision of a mattress would be dependent on the level of risk

The Panel considered the statistical data illustrated in the report, particularly relating to avoidable pressure ulcers and the number of community acquired pressure ulcers (CAPU).  The panel were informed that the hospital acquired pressure ulcers (HAPU) are related to patients with acute issues and that these patients can come from a wider surrounding area. CAPU and HAPU enter the hospital through emergency portals in addition to scheduled surgical procedures.

Cllr Craig Collingswood asked about the Key Performance Indicators (KPIs) and if Wolverhampton bench marks against other parts of the Country. Katey White advised that there are different grading systems in each organisation and that ulcers are classified differently. Wolverhampton grade as follows:

Grade 2 = blister

Grade 3 = open wound

Grade 4 = deep wound can see bone

She clarified that Wolverhampton is open reporting and following European Union (EU) guidelines; whilst other areas may not be as open and that this is difficult to benchmark against.

The Panel discussed the issue of prevention and the need to have one patient record accessible to all health partners. Cllr Stephen Simkins highlighted that if there were one patient record risk could be highlighted and prevention prioritised.

Stephen Marshall CCG outlined the CCG approach to prevent pressure sores through work with 12 General Practitioners (GPs) and 18 residential nursing homes. He clarified that the CCG records the number of patients in residential nursing homes with pressure ulcers by counting the instances.

Cllr Peter O’Neill questioned if GPs gave advice to prevent pressure ulcers.  The panel questioned the communication of information relating inherited to pressure ulcers between hospitals, district nurses and GPs.

Cllr Milkinderpal Jaspal, Chair highlighted the panels concern and indicated that this was one weakness in the system and a very good point officers to take on board  

Cllr Stephen Simkins suggested that neighbouring authorities should be contacted to work across the communities and to share the good practice highlighted in the report. He requested clarification if social work teams are made aware of pressure ulcers when patients are discharged from hospital.  Rose Baker confirmed that this was flagged up to social services and the GP in the discharge pack.  She advised that not all discharges are referred to social worker and that the GP would be made aware, follow up contact is at the discretion of the individuals GP. She clarified that district nurses have the responsibility to attend the patient in their home following discharge and to monitor pressure ulcers.  The Service Director confirmed that the discharge part is under the remit of the CCG but that there is a system wide approach.

The Chair, welcomed the recommendations for action outlined in the report and asked if timescales had been agreed.  Rose Baker advised that the first meeting had taken place but the strategy would not be a simple strategy and timelines were yet to be agreed. The Chair indicated that the points raised in discussion relating to training and education were covered in the action points.

The Chair thanked officers for attending the meeting and for the report, he summarised that a lot of good points had come from the discussion.

Recommend

1.      That any future commissioning specifications include the need to have training for care workers in relation to pressure ulcers.