2. Improving wound management through inter-professional collaboration.
Michael Clark PhD

3. Public View of Wounds

4. The reality of Clinical Practice

5. Cost at all- Wales level (£)
Impact in Wales
Resource utilised
Number in cohort
Unit cost (£)
Cost (£)
Cost at all- Wales level (£)
Initial GP visit
78,090 45
3,514,050
8,570,854
Subsequent GP visits
1,249,809 13
16,247,517
39,628,090
Number of dressings
2,344,930
3,964,537
9,669,602
Number of district nurse attendances
703,479 35
24,621,765
60,053,085
Number of out- patient attendances
68,662
120
8,271,711
20,174,905
Number of in- patient episodes
14,697
78,204,577
190,742,871
Total expenditure
134,824,157
328,839,408
Average cost per patient

6. National audit of pressure ulcers, incontinence-associated dermatitis and other wounds
Clark M1, Semple M2, Ivins N1, Mahoney K1, Harding KG1
1 Welsh Wound Innovation Centre, Llantrisant, Wales, UK
2 Welsh Government, Cardiff, Wales UK

7. Risk of pressure ulcer development
Mattress allocation
Risk of pressure ulcer development
Product type
No risk
Low
Medium
High
TOTAL
Foam mattress
1198
1665
862
663
4388
Other static mattress/overlay 40
223
299
533
1095
Low Air Loss/Specialty bed 1 7 15 23
Hybrid product 2 22 70
101
Dynamic overlay 4
119
186
Dynamic replacement 36
161
323
644
1164
1280
2080
1553
2044
6957

8. Hybrid mattresses
Dynamic hybrids stated to reduce time to obtain and allocate dynamic mattresses from 434 minutes to 0.

9. Powered Hybrid mattresses in NHS Wales 2017
Health Board
Community
Acute
Abertawe Bro Morgannwg UHB NO
✓ Invacare
Aneurin Bevan UHB
No information returned
Betsi Cadwaladr UHB
✓ Direct Healthcare
Cardiff & Vale UHB
✓Being introduced (Medstrom)
✓ Medstrom
Cwm Taf UHB
Perhaps in future
Hywel Dda UHB
Powys Teaching Health Board
✓ Community Hospitals (Direct Healthcare, over 200 in use)
No acute units

10. Pressure Ulcer Prevention and Intervention Service
Collaboration
Pressure Ulcer Prevention and Intervention Service

11. Evaluation process Show and Tell Lab test Clinical 8 products
Infection control
Manual handling
Clinical engineering
Tissue Viability
Objective scoring criteria
Contact pressures measured at sacrum and heel 10 able bodied volunteers
Clinical evaluation within 2 orthopaedic wards

13. Clinical evaluation

14. What about the test wards?
The two powered hybrid mattresses were used on two separate orthopaedic wards
Ward 1
Ward 2
Significance
Number of patients 17 18
Age (years), mean (SD)
82.6 (8.3)
74.9 (15.7) NS
Length of sitting during day (under:over 6 hours)
7:8
3:6
Risk (PSPS)
Low
Medium 8
High
Low
Medium 5
High
Significant
Able to change position independently (Y:N)
7:10
9:9
Frequency intentional rounding
< 2 hours 5
2 hours
3-4 hours 2
Other
< 2 hours 0
2 hours 2
3-4 hours 13
Other

15. What about the test wards?
Differences between the patients nursed on the two wards; Ward 1. Older, higher risk of pressure ulcers, more frequent scheduled nursing (Mattress A) Ward 2. Tended to be younger (but with wide spread of ages), at lower risk of pressure ulcers, less frequent scheduled nursing care. (Mattress B) Not a direct head-to-head comparison of the two mattresses given different patient mix

16. A
Pressure ulcers present at start of evaluation n=5 (Heel n=4; Sacrum n=1) Category II n=2 : Category III n=3 Pressure ulcers developed during the evaluation n=4 (Heel n=4) All Category II

17. B
Pressure ulcers present at start of evaluation n=4 (Buttock n=2; Sacrum n=2) Category II n=3 Pressure ulcers developed during the evaluation n=1 (Heel n=1) Category II

18. Next steps in WWIC
ISO 20342: Assistive products for tissue integrity when lying down.
Space identified within WWIC to develop accredited test lab.