It stands to reason that collaboration may be the key to lowering the rate of pressure injuries. After all, the more people work together, the better they understand how they can help each other. The better the lines of communication between patients, their caregivers, and their families, the higher the chance that the care generated will be personalized and effective.
But collaboration can go much further than within treatment and solutions in any single facility. It can include the wisdom and experience of an entire culture. That's one of the principles behind the Stop the Pressure Program (STPP) across England.
The programs aims to reduce the number of cases of pressure injuries in England. According to Prof. Jacqui Fletcher, RN and Senior Clinical Advisor, the program’s goals include setting national definitions, improving pressure injury education at all levels, and finding ways to get the public involved.
One of its most exciting achievements has been to collect and review no fewer than 172 prevention plans from trusts across the country. Looking at the themes that appear repeatedly in the plans - and especially at the subjects that are largely absent - sheds light on the state of pressure injury prevention in England, and plots where to go from here.
Common Themes in Prevention Plans
Taken together, the 172 plans from across England (though not all of the UK) present a large-scale view of the state of pressure injury prevention. The themes that appear time and again reveal the areas of consensus among those looking to reduce pressure injuries.
Some of the highlights of the reports include:
1. Leadership - for a plan to succeed, it must be led by the executive staff of a treatment facility, rather than just the clinical staff.
2. Partnerships - hospitals were most successful when they worked in coordination with their local communities, nursing homes, and even local academics. Hospitals running independent programs were less successful. This point underscores the importance of collaboration on every level.
3. Equipment - there is no doubt that having timely access to equipment makes a difference to care. How big a difference, however, varies between the plans.
4. Education – Prof. Fletcher noted that "everybody talked about the need for MORE education but nobody talked about evaluating the IMPACT of the education. How do we deliver it in the most impactful fashion? How do we measure impact?”
Prof. Fletcher added that another common theme was the use of data and measurements. She noted that many facilities were doing a great job collecting and reporting data, but it was unclear if the facilities always understood the significance of the figures they were reporting, or how to use them, especially as they pertain to pressure injury prevention.
What the Plans are Missing
Reducing pressure injuries, especially on a national level, starts with taking the pulse of the field, finding out where the emphasis is, and looking for ways to take the next step. What the plans leave out points to how treatment can be improved, and more importantly, which areas have yet to reach consensus.
1. Any mention of nutrition - while the link between skin health and nutrition has grown in acceptance, it has not yet become a fundamental element of prevention for those responsible for implementing pressure injury reduction plans.
2. The experience of the patient - while trends point to greater input from the patient on the type of care best suited to the situation, there is room for more focus on the patient in the improvement plans.
3. Seated patients – While the discussion of mattresses and other equipment improvements for bed-ridden patients is common, there is more discussion necessary about the needs of patients who spent much of their day in wheelchairs or other sitting positions.
4. Bariatric care (larger people) – There is virtually no mention of how to manage larger patients to decrease pressure injuries.
The list above indicates that the review of plans has identified a number of areas which need added focus and dedication. That's one of the greatest benefits to a national program like the Stop the Pressure Program – it identifies which factors remain to be studied.
Implementing the Next Steps
Bringing together so many different perspectives can help broaden everyone's understanding. Seeing what the plans have in common can help build confidence in the direction of the care and provide a basis for collaboration on practices already being implemented.
The section on what's missing may turn out to be even more important. The list identifies exactly what needs to improve, providing each of the trusts with a roadmap to taking their plans to the next level.
Working together makes sense for everyone. Care workers rely on support from their health facilities and from the families of the patients. Learning more about what each party needs to be more effective can only make the process more efficient and help more patients avoid developing pressure injuries.
Together, the numbers can be brought down. Reviewing the plans is a powerful first step in that direction.