A Sneak Preview of our Programme No. 3!

Justin Keen, Jane Nixon & Susanne Coleman- 1st time presentation of results from the NIHR PURPOSE Programme

Justin Keen – Severe Pressure Ulcers: How organisational contexts influence their development

There is suggestive evidence that the organisation of health care can contribute to the development of severe pressure ulcers. The study sought to improve our understanding of role of organisation, by identifying eight patients who had developed a Grade 3 or 4 pressure ulcer, and then retrospectively re-constructing the events that led to their development. Reconstructing historical events can be fraught with difficulties: those involved can have different recollections of events, and key information cannot be found in records. Even when reviews are done painstakingly, it can be difficult to establish how far the wider organisational context – the prevailing culture, staffing levels, ward closures – contributed to the development of severe pressure ulcers. The study findings suggest that, while it is possible to identify specific problems such as staffing levels or poor communication, patients developed severe pressure ulcers in environments where there was a general governance failure. Staff in the settings studied had, for whatever reason, adopted working routines that resulted in sub-optimal treatment and care.

Jane Nixon – Is pain a predictor of Category 2 pressure ulcers? Results of the PURPOSE Pain Cohort Study

Background
Pain is an important symptom which aids the diagnosis of many conditions. A systematic review of health related quality of life in patients with pressure ulcers (PU), identified that patients’ reports of localised skin pain associated with early PU development are ignored1,2,3. This study was a prospective cohort study that explored the role of pain as an early predictor of Category 2 PU development.
Methods
We conducted a prospective cohort study with 30 days follow-up, in 26 acute and community NHS centres involving patients at high-risk of PU development. High risk was defined operationally as having one or more of the following characteristics: Braden bedfast/chairfast AND completely immobile/very limited mobility; localised skin pain on any pressure area skin site; Category 1 PU on any pressure area skin site.
Results
Of 3826 patients assessed 634 were registered to the study. Logistic regression was used to determine whether the presence or absence of pain on a pressure ulcer free skin site at study entry was predictive of the development of a new Category >2 PU, after allowing for the other a priori factors of interest including age, diabetes, history of prior weight loss, mobility (Braden Scale), presence of skin alterations (Category A); presence of category 1 PU, setting (acute or community) and analgesic/pain relief use.
Conclusions
The presentation will provide an important insight into the importance (or not) of assessing and responding to patient reported pain on pressure ulcer free skin sites as part of a pressure ulcer prevention strategy.
References
1. Spilsbury K, Nelson A, Cullum N, Iglesias C, Nixon J, Mason S. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. Journal of Advanced Nursing 2007; 57(5):494-504.
2. Hopkins A, Dealey C, Bale S, Defloor T, Worboys F. Patient stories of living with a pressure ulcer. Journal of Advanced Nursing 2006; 56(4):345-353.
3. Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, Defloor T, Nixon J, on behalf of the European Quality of Life Pressure Ulcer project (EQUIP) group (2009). Impact of pressure ulcers on quality of life in older patients: A systematic review. JAGS 57:
1175-1183.

Susanne Coleman – From systematic review to clinical practice – risk factor domains to be considered in pressure ulcer risk assessment

Introduction: Risk assessment is viewed as the cornerstone of pressure ulcer prevention but
existing risk assessment tools are now outdated. New evidence makes it timely to re-consider the risk factors that should to be incorporated into risk assessment practice.
Method: An overview of a consensus study to agree the key pressure ulcer risk factor domains/sub-domains that should be included in pressure ulcer risk assessment will be presented. It will detail the nominal group technique used and how new evidence including a
pressure ulcer risk factor systematic review and wider scientific evidence, as well as the views of patient’s and carers were integrated into the methodology.
Results: The agreed risk factor domains/sub-domains will be highlighted as well as uncertain areas that may require further research. A new pressure ulcer conceptual framework will also be presented.
Conclusion: The consensus study has provided the foundation for the development of pressure ulcer minimum data set (PU-MDS) and a new risk assessment framework – PURPOSE T (Pressure Ulcer Risk Primary