Improving pressure ulcer risk identification: a pilot project by ambulance staff
Abstract
Background:
A quality improvement initiative was designed to identify patients at risk of compromised tissue viability before they were admitted to hospital. Paramedics were educated to better identify patients with pressure ulcers or pressure damage, or those at risk of compromised tissue viability, and these patients were fitted with a pressure ulcer alert bracelet so that emergency department staff could identify them.
Aims:
The aims of the current initiative were to educate paramedics to better identify patients with pressure ulcers or those at risk of compromised tissue viability to emergency department staff, and fit them with a pressure ulcer alert bracelet to highlight them to emergency department staff so they would receive prompt intervention.
Methods:
A plan, do, study, act improvement methodology was used, and data from a 3-month period were retrospectively analysed. Patients identified as being at risk of compromised tissue viability were flagged as requiring assessment via a pressure ulcer risk assessment tool to enable prevention.
Results:
Paramedics identified 130 at-risk patients (aged 23–100 years), and data from 127 patients were analysed. Most at-risk patients fitted with pressure ulcer alert bracelets were aged 70 years or over, and there was an even female/male division. More than half (53%) of patients were found to have a pressure ulcer and alerted to emergency department staff. More than one in four (27%) patients who were identified as being at risk of pressure ulcers lived in nursing or residential homes, and 43% lived alone or in warden-controlled accommodation.
Conclusions:
Paramedics effectively identified potential risk factors for pressure ulcer development, indicating a need for immediate intervention. This study gives insight into how pressure ulcer risk assessment using an alert bracelet may be used in paramedic practice in emergency department handovers. Success depends on hospital staff acting upon paramedic recommendation.
Immobility predisposes patients who are already at a high risk of skin breakdown to develop pressure ulceration. Being able to assess and monitor patients at an elevated risk of tissue breakdown is one way to reduce the overall number of patients who progress to the stage of pre-ulcerative or ulcerative conditions—both of which significantly reduce quality of life.
The current report describes a small-scale quality improvement pilot intervention study designed to minimise the risk of pressure ulcer (PU) development or a deterioration of tissue viability in patients of a regional ambulance service in the north east of England. The study was conducted between October and December 2017.
This intervention included the introduction of a ‘pressure ulcer alert’ bracelet by paramedic practitioners working for the North East Ambulance Service (NEAS), who also implemented a PU risk assessment tool for patients who had to be admitted to an acute hospital trust. The project was part of a pressure ulcer collaborative intervention facilitated by the Academic & Health Science Network for the North East and North Cumbria using a recognised quality improvement methodology.
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