Maidstone and Tunbridge Wells NHS Trust is a trust with approx. 800 beds spread across 2 large hospitals and a 12 bedded satellite ward at a cottage hospital. Joan Bedo, Tissue Viability CNS, and Mark Vince, Safety Thermometer Manager, discussed their trust’s improvement journey.
Where did your improvement journey start?
Five years ago our pressure ulcer incidence was pretty high, we were above national averages. We took note of this and introduced a few different things to start improving. One of these was changing our mattress stock style, which made a difference. Another was a shift in the way people were looking at pressure ulcers, this was due to education plans we had put in place and also the fact that the new Deputy Chief Nurse made it his business to make sure the board new about pressure ulcer prevalence. That ensured buy-in from the top level, which was important.
Was education key to the improvement?
I think that education was crucial in our improvement particularly as we involved as many people as we could in it. We had great engagement from ward managers with the education, we did two link-nurse days a year and we included the clinical support workers on those too. This was because they are on the frontline doing the work and reporting, so they need to be educated in pressure ulcers.
How did using the Safety Thermometer affect the trust?
We began using the Safety Thermometer around 18 months ago and since then we’ve seen 83% reduction in pressure ulcers, which is great. But at the start we had some issues around the reliability of our reporting as our numbers were not matching up to the Safety Thermometer numbers.
There were leg ulcers and moisture lesions being reported incorrectly as pressure ulcers, this made us become very critical on what was being reported and improve our reliability.
How did you improve the reliability of the reporting?
We ensured that every single hospital acquired pressure ulcer reported is attended by Tissue Viability Nurse, this allows us to determine what is actual pressure damage and what has been reported incorrectly.
How is the Safety Thermometer data collected and reported?
The data is collected by myself (Mark Vince) and then sent to the Deputy Chief Nurse for sign-off and submission. Once it has been submitted, the Chief Nurse will review it and query any unusual spikes or lows. The communications team also have a look at it as it’s in the public domain and it is discussed at the monthly board meeting.
The Tissue Viability team have also been reviewing the data to see which wards are going 30, 60 or 90+ days without pressure ulcers. We then feed this back to the teams and celebrate their successes.
What have been the advantages of using the Safety Thermometer?
It helps us to confirm our numbers that we were previously collecting and spot trends. The trends include wards that have seen improvements and we are able to look at practice here, identify the learning and share this across all areas. The Safety Thermometer also helps with ‘early warning’; if a ward trend is adverse, we are able to provide support and intervention early.
What would be your advice to trusts looking to improve using the Safety Thermometer?
One piece of advice is to support wards or teams that may be struggling and then reward them when they improve. Another major one is engagement, particularly from senior people. If you get the board, Chief Nurse and Deputy Chief Nurse on-board it helps a lot.
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