1. Stopping the Pressure through Education & Training
Dr Lisa Bayliss-Pratt Assistant Director of Nursing NHS Midlands and East Pauline Milne Deputy Head of Education and Development East of England Multi-Professional Deanery Tracy Burrell Acting Assistant Director of Nursing Blackpool Teaching Hospitals NHS Foundation Trust Lorraine Thursby Service Lead Manual Handling & Tissue Viability George Eliot Hospital Frances Igbonwoke Associate- Safer Care NHS Institute for Innovation and Improvement
To include Tracy Lorraine

2. Assistant Director of Nursing NHS Midlands and East
Dr Lisa Bayliss-Pratt
Assistant Director of Nursing
NHS Midlands and East

3. Objectives of Session are to:
provide an overview of the Pressure Ulcer education and training workstream
explain the concept of the Pressure Ulcer education and training framework
discuss Pressure Ulcer education and training in the context of a continuous learning environment
share examples of how Pressure Ulcer training can be systematically implemented
1. LBP 2. PM 3.FI 4/5/ TB/LT.

4. To eliminate avoidable grade 2, 3 & 4 pressure ulcers by December 2012
Cluster Ambition:
To eliminate avoidable grade 2, 3 & 4 pressure ulcers by December 2012
LBP Background to ET WORK COMMENCED IN EARNEST IN AUGUST AND SHOULD READY FOR USE BY SEPTEMBER

5. IT GOES WITHOUT SAYING IS WORTHWHILE

6. Linked to: Stop the Pressure Campaign SSKIN Pressure Ulcer Pathway
Safety Thermometer / CQUIN
Intensive Support Visits
Communication and Engagement Campaign
PAULINE TO TALK TO – Pauline we need to emphasis that we are not talking about above

7. Pauline to discuss how they won this award

8. Pauline – linked to I trust you care which emphasises a partnership approach

9. IST Learning: Key Findings
Availability and timeliness of pressure relieving equipment
Variable levels assessing competence
Training focused heavily on management rather than prevention
Root Cause Analysis often showed failure to assess correctly, not having appropriate care plans in place
Nursing documentation varied in quality and completion
Non–concordance was regularly cited as a reason for patients acquiring an unavoidable pressure ulcer – this requires further exploration
Many organisations recognised the benefits of using the safety thermometer
Assessing avoidability was variable across the SHA Cluster as a whole
Lisa to talk to read the report and input the key learning - move to slide 8 after the SSKIN

10. Pauline Milne Deputy Head of Education and Development
East of England Multi-Professional Deanery

11. Aims of the Pressure Ulcer Education & Training Framework
Clarify roles and responsibilities in relation to pressure ulcer prevention from ‘board to ward’
Develop learning outcomes relevant to staff groups
Provide easy access to existing learning materials & good practices
Develop a web based platform to host and maximise access to the framework
Explore accreditation of the framework for the future

12. Why a framework… To share existing good practices
To enable individuals and organisations to determine pressure ulcer education and training needs for their entire workforce
To raise the profile and priority of pressure ulcer education and training across the workforce
To bring together existing pressure ulcer education and training materials into one central accessible repository

13. Structure of the Framework
The PU Education and Training Framework includes roles and responsibilities, learning outcomes and education materials for the following:
Patients, Lay Carers and Relatives
Non Clinical Staff
Non Registered Clinical Staff
Registered Practitioner
TV Link Nurse / Clinician
Sister / Charge Nurse / Team Leader / Matron
TV Specialist Nurse
TV Service Clinical Lead
Board Member
Leave with Lisa to play with a visual image

14. Content of the Framework
Web based learning package but materials can be saved / printed off / adapted for local use
Examples include:
Patient information leaflets
Mandatory training presentations
Competency workbooks
Toolkits
Research articles

15. Application of Framework
Job type
Roles and Responsibilities
Learning Outcomes
Pressure Ulcer Education and Training Materials
Sister / Charge Nurse /Departmental Manager / Team Leader / Matron
To ensure all patients in your clinical area receive high quality care
To be responsible, accountable and role model the delivery of high quality care which will prevent the development of pressure ulcers
Ensure a skilled and competent workforce through staff appraisal, clinical supervision and personal development planning
Promote an open and honest culture
Instigate the Root Cause Analysis (RCA) process and take corrective action in response to findings
Ensure lessons are learned from root cause analysis and resultant changes in practice implemented
Early recognition of where safety lapses have occurred and take corrective action through established governance processes
Promote a culture of zero tolerance to avoidable pressure ulcers
Monitor, analyse and challenge the impact of Improvement Programmes including the data that is reported i.e. NHS Safety Thermometer, serious incidents, and harm free care
Identify and disseminate good practice and learning in relation to pressure ulcer prevention, treatment and harm free care
Assure Director of Nursing / Trust Board that lessons have been learned and actions taken to ensure the prevention of pressure ulcers in area of responsibility
Role model and deliver intentional rounding ensuring this does not become a ‘tick box’ exercise
Effectively implement clinical improvement programmes and monitor their impact (for example Productive Ward, HIA, Safe Care)
Ensure that all relevant risk assessments/ impact ( i.e. Waterlow/Braden/MUST/Walsall) and pressure ulcer interventions (i.e. SSKIN, STOP the Pressure) are fully understood by staff, implemented appropriately and their impact monitored
The learning outcomes of a Registered Practitioner and Tissue Viability Link Nurse / Clinician are assumed as a baseline.
Additional learning outcomes for the Sister / Charge Nurse / Departmental Manager / Team Leader / Matron role are:
Demonstrate an in-depth understanding of the actions required to eliminate avoidable pressure ulcers in your area of responsibility
Articulate the actions required to promote an open, fair culture and a high quality clinical learning environment
Articulate how to lead the investigation of a Clinical Incident / Pressure Ulcer, including implementation of the recommendations through robust action planning
Demonstrate how ‘Harm Free Care’ is championed in your area of responsibility
Demonstrate the ability to triangulate the NHS Safety Thermometer data with other relevant data sets e.g. Serious Incidents reports, complaints/concerns etc.
Assumes access to the learning materials available to Registered Practitioners and Tissue Viability Links Nurses / Clinicians.
The pressure ulcer education and training materials listed below are in addition to those available to Registered Practitioners and Tissue Viability Link Nurses / Clinicians.
‘Habits for Improvers’
Undertake and be competent at the NHS Safety Thermometer training accessed from the ‘Harm Free’ Care website
and Safety Thermometer guidance
Basic Patient Safety Theory; Root Cause Analysis Training.
Audit/Review Visit skills e.g.. ‘walk abouts’
Understanding and challenging Safety Thermometer data prevalence/incidence/grades
NHS Seven Steps to Patient Safety
Guidance on Quality Dashboards
RCA guidance
RCA Toolkit
NHSI Improvement Tools – cross reference to FI materials
NHS Midlands and East Policy for the Reporting and Management of Serious Incident in the East Midlands
NHS Being Open Guidance: Communicating patient safety incidents with patients, their families and carers
Appraisal/Clinical Supervision Guidance
Check with HR / website

16. Associate-Safer Care NHS Institute for Innovation and Improvement
Frances Igbonwoke
Associate-Safer Care
NHS Institute for Innovation and Improvement

17. Equipping to eliminate avoidable pressure ulcers grades 2-4
Primary Outcome Primary Drivers Secondary Drivers
1.Competency frameworks and workbooks
2. Buddying/shadowing and mentoring
3. Webinars, e-learning, DVDs
4. Learning networks and best practice forums
Access to Knowledge
Building capability to prevent and eliminate avoidable pressure ulcers grades 2-4 by Dec 2012
Competent care delivery
Knowledge of roles and responsibilities
Assessed competencies
Verbal & documented communication by care giver
Education materials and resources
3. Learning, sharing and support groups
Patient and carers equipped with knowledge
Continuous Learning
1. Measurement
2. Agreed improvement methodology
3. Knowledge and design of consistent ‘reliable’ care processes
4. Continuous learning from incidents, tests of change

18. NHS Change Model www.changemodel.nhs.uk
Leadership instilled culture of learning
Real-time access to knowledge
Working and learning collaboratively with all partners, patients and carers
A framework for studying and improving care processes to achieve consistently good outcomes
Quality incentives and standards lined up to prioritise staff training
Robust delivery of ongoing team training and skill building, analysis for and creation of feedback loops for continuous learning and system improvement
Systematically monitoring safety, quality, processes for their impact on patient outcomes and efficiency

19. Supporting Resources
‘Your skin matters’ (Energising for excellence, High Impact actions for nursing and midwifery)
The Productive Operating Theatre- Consumables and equipment
Harmfree care website
NHS Change Model:

20. Tracy Burrell Acting Assistant Director of Nursing
Blackpool Teaching Hospitals NHS Foundation Trust

21. The Story from Blackpool:
Achieved in the last 3 years:
64% reduction in the number of Hospital Acquired Pressure Ulcers
> Grade 2 over the last 3 years
33% reduction in the number of patients acquiring a pressure ulcer whilst in their care.
Between April 2011-March 2012:
30% reduction in the number of hospital acquired pressure ulcers
Over 50% of nursing staff undertaken training in pressure ulcer prevention (e-learning and/or pressure ulcer prevention work book).

22. How Blackpool achieved Results (1)
A Shared purpose
A stronger focus on prevention of pressure ulcers
Re-energised Pressure Ulcer Prevention Group focussing on improving patient safety and experience through prevention of pressure ulcers
Corporate and local driver diagrams
Engaging to mobilise
Increased ownership and engagement from the clinical divisions
Leadership for change
Enhancing the Ward manager role
Enhancing the Matron role
Re-focussing of Link nurses

23. How Blackpool achieved Results (2)
Rigorous delivery
Introduction of a pressure ulcer workbook that all staff must complete – linked to appraisal/OLM
Introduction of e-learning package for all nursing and Midwifery staff
Matrons’ training as part of accredited development programme
Launch of the Skin and Safety walk round tool (intentional rounding)
Local action plans to improve prevention of pressure ulcers
Transparent measurement
New more meaningful reporting format
Revised RCA reporting to standardise with current Trust practice
Tissue viability as a Nursing Care Indicator Metric
Spread of Innovation
Share point intranet information site
Revision of TBM

24. How Blackpool achieved Results (3)
Improvement methodology
Improvement of clinical systems
Improvement of staff education / skills / competencies
Staff engagement / ownership
Statistical Analysis / Evaluation
System drivers
Reduction in preventable harm:
Local Trust target 30% reduction in year 11/12
CQUIN target - nurse training / education
Improved quality of patient care / experience

25. Blackpool Next Steps: Engagement with Community staff
Sharing best practice
Improved reporting for community
Standardising practice / documentation post amalgamation
Revise wound care formulary
Improving referral / continuing care systems

26. Service Lead Manual Handling & Tissue Viability George Eliot Hospital
Lorraine Thursby
Service Lead Manual Handling & Tissue Viability
George Eliot Hospital

27. An example from George Eliot Hospitals (1)
Engaging medical staff right from the start:
Pressure ulcer awareness received by junior doctors on arrival on day one as part of manual handling induction
Further manual handling sessions to further increase awareness
Pressure ulcer prevention training linked in Post Graduate training within first three weeks of induction
Result
Doctors actively assessing the patients’ skin on arrival
one inspired consultant gastroenterologist now engaged in the Pressure ulcer change programme taking forward work to reduce pressure ulcers through improving nutrition and hydration

28. An example from George Eliot Hospitals (2)
Pressure ulcer prevention, everyone learning, everyone’s business:
Routinely part of manual handling highlighting correct handling techniques to minimise impact of shear and friction on skin; effective use of pressure relieving beds, mattresses and the MUST for all assisted-handling to have slide sheets
Clinical Mandatory Updates: All disciplines including medical staff receive key messages in pressure ulcer prevention from both Manual Handling and Tissue Viability
Result:

29. What have we achieved so far?
Nurse Sensitive Indicators data for Tissue Viability and Nutrition prior to medical education and launch of Trust PUP campaign (February 2011)
Nurse Sensitive Indicators data Q1 2012/13 for Tissue Viability and Nutrition following active medical education in both Tissue Viability and Manual Handling

30. What have we achieved so far?
Last grade 4 hospital acquired avoidable pressure ulcer - August 2011
Last grade 3 hospital acquired avoidable pressure ulcer - November 2011
Last year’s final total of grade 2 post 72 hours avoidable/unavoidable pressure ulcers: 154
To Excel at Patient Care

31. Assistant Director of Nursing NHS Midlands and East
Dr Lisa Bayliss-Pratt
Assistant Director of Nursing
NHS Midlands and East

32. Summary
Building capability to prevent and eliminate avoidable pressure ulcers is a priority
Continuous learning system is key to maintaining a skilled workforce and achieving change at scale and pace
Continuous feedback from YOU!

33. QUESTIONS & DISCUSSION