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Benchmarking in A&E Abstract: The Department of Health published the 'Essence of Care - patient-focused benchmarking for health care practitioners' in February 2001. Of the eight areas highlighted the A&E Department chose to look at pressure ulcers. The author discusss the benchmark used, and how she became involved in this project. Contents: Back to Progress in Practice Essence of Care patient focused benchmarking is part of the NHS plan. It was developed to provide a better quality of care for our patients. There are eight areas highlighted, and within the A&E department the first area of care chosen to develop was pressure ulcers. The NHS plan was published in 2000, and within this document it was identified that both patients and carers wanted better quality of care. As a result of this, an action plan to improve the quality of nursing and midwifery was formulated. This informed nurses of the need to re-focus on the fundamentals of care. (1) There are eight areas highlighted: Ø Privacy and dignity. Ø Principles of self-care. Ø Food and nutrition. Ø Personal and oral hygiene. Ø Pressure ulcers. Ø Record keeping. Ø Continence and bladder and bowel care. Ø Safety of clients/patients with mental health needs in acute mental health and general hospital settings.The way in which I initially became involved with the essence of care project was whilst I was a member of the A & E Clinical Nursing Practice Group. We were all asked to choose an area of care within our practice setting. Once the area was chosen, we needed to lock at and develop a plan to improve on this within the Essence of Care framework. I chose pressure ulcers, as it was an area of patient care that I am interested in. Also, it is an area of patient care that can be overlooked in a busy A&E department. I took this idea to the A&E Clinical Practice Development Forum (CPDF), where I was fully supported to take the work forward. In order to begin the background work, I needed to understand the aetiology of pressure ulcers. I was fortunate to already have the Trusts Wound Care Manual, and the support of the Senior Nurse for Tissue Viability. Additionally, I had carried out a literature search on pressure ulcers in A&E, and found that very little research had been carried out in this area. Tarpey et al suggest that this may be due to the consideration that patients are in transit and would be quickly admitted to a ward or discharged home from A&E. (2) However, given the pressure on beds within the Health Care Trusts, patients can spend long periods in A&E. Having identified the benchmark, a comparison group was formed, comprised of the following members:
The remit of this group was to scrutinise current pressure area care, using each of the nine factors out lined within the benchmark. This included the group scoring each factor to decide what standard of practice was currently being provided in A&E and to decide upon an action plan to improve practice. The nine factors involved to assess the level of care provided for patients who have pressure ulcers or those who are at risk within the A&E department, are listed below. The rationale of why benchmarking this specific area of care is required is also included, as well as a definition of best practice. Pressure ulcer (sometimes referred to as Pressure sore/Bed sore/Decubitus ulcer) = identified damage to an individual's skin due to the effects of pressure together with, or independently from a number of other factors e.g. shearing, friction, moisture etc. Agreed Patient/Client Focused Outcome The condition of the patients/clients skin will be maintained or improved Indicators/Information that highlights concerns which may trigger the need for benchmarking activity:
It is important to note that these factors are not tablets of stone and can be interpreted to suit individual areas. Following this meeting, I returned to the CPDF and formed a subgroup of interested nursing colleagues. The group brainstormed a list of ways to improve the quality of patient's care based on the findings in the scoring phase. Ø Development of a further assessment/management chart for patients who are identified at risk (including a turning chart). ØObtaining more moving and handling aids. ØObtaining more pressure relieving aids. ØTeaching and raising awareness of pressure area prevention for patients, relatives and staff.Since this meeting the subgroup has completed an easy to use care plan for patients at risk of pressure ulcers. The plan is currently under audit and amendments will be made. An example of this care plan is below. Accident & Emergency DepartmentPressure Ulcer Risk Assessment Tool Waterlow Score:
(See Trust Wound Care Manual)
Date:
Funding for pressure relieving aids was provided from the £5,000 Sister/Charge Nurse budget allocated to the A & E department from the government. These aids have greatly improved patient's comfort on A&E trolleys. Additionally, teaching was provided to increase awareness of pressure ulcer avoidance strategies to as many nursing staff as possible and a teaching information board set-up in the department. Developing this essence of care project has taken an enormous amount of work and time (eighteen months to get this far), and it now needs to be evaluated and developed further. Nevertheless, it has been well worth it! The way forward for improving pressure ulcer prevention has been initiated in the A & E department. In the era of increased technology and information, it is important to give priority to these important areas of patient care. Progress in Practice: 2002.Copyright: Progress in Practice, 1. Department of Health. The Essence of Care. London:Stationary Office. 2001. 2. Tarpey A, Gould D, Fox C, Davies P, Cocking M. Evaluating support surfaces for patients in transit through the accident and emergency department. Journal of Clinical Nursing. 2000: 9;189-98. Back to TopBack to Progress in Practice Essence of care: Barts & The London strategy Essence of care: progress in 2001 Page last updated by DEB on 31/03/03 |
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