We knew that we had unacceptable levels of skin breakdown in our local system because our specialist tissue viability services were struggling with an ever growing, and increasingly severe case load; but we weren’t sure where the harm was happening or what we could do to prevent it. Pressure ulcers, leg ulcers and skin tears cause pain and distress to older people and can be avoided by a systematic approach to prevention, assessment and early management; but this clearly was not happening in the Thames Valley. It seemed that there were a significant number of avoidable admissions and inappropriate referrals to tissue viability services which could be better managed if generalist staff across the system were working in a coordinated way.
Improving skin care is a catalyst to improving care of the elderly more generally, as good skin care includes nutrition, hydration, mobility, falls avoidance and pain management. Measurable improvements can only be delivered across a health and care system by involving all the key players in collaborative partnership. Our aim is to reduce the prevalence of tissue viability problems and to assess and manage harm earlier where it happens. Our approach used the Institute of Healthcare Improvement (IHI) methodology which systematically evaluates harms, identifies those which were avoidable, and analyses their causes and ways to stop incidents happening again. This approach is supplemented by a training needs analysis to identify and fill gaps in knowledge and understanding, sharing learning to create local learning communities across the whole pathway. We believe this will lead to a common culture across the whole system with a shared understanding of how to care for the frail elderly.
This webinar tells the story of the journey so far:- SKINtelligence Webinar