Implementing the aSSKINg pressure ulcer care bundle – a blog by Susan Martin

Summary

In this blog, Susan Martin, a Tissue Viability Specialist Nurse at East Sussex, describes how she implemented the aSSKINg model (assess risk; skin assessment and skin care; surface; keep moving; incontinence and moisture; nutrition and hydration; and giving information or getting help) for pressure ulcer prevention into her Trust.

Content

The incidence and prevalence of pressure ulcers continues to rise in England despite national and international guidance. When I was considering what to do for my MSc dissertation as part of the Wound Healing and Tissue Repair programme at Cardiff University, I wanted to explore how we were doing as an organisation. As a Tissue Viability Nurse Specialist, I was familiar with aSSKINg, which is a pressure ulcer care bundle, although we had yet to implement it within our organisation.

Data collection

A clinical audit to determine the organisation's compliance against the aSSKINg framework for pressure ulcers seemed like a good place to start. I completed the required clinical audit paperwork and started collecting data from adult community nursing caseloads in the East locality.  The Trust is large and, as I was a single auditor, one locality was chosen to determine our compliance. 

I adapted a data collection tool from another clinical audit undertaken in acute trusts for a community setting. The audit covered the period July to December 2021 and I had access to 3000 patient records alongside clinical incident reports. Overall, 418 patients were identified as having a pressure ulcer in the audit period. Pre-audit work to determine if the data collection would be successful involved removing 20 patients and checking the data collection tool. I subsequently completed a pilot audit in another locality (West) and further amendments were made to the data collection too.  Of the remaining 398 patients in East, they were randomised using a number generator app and 150 patients were randomised to audit. 

Baseline data and aSSKINg pilot

The baseline data from the audit highlighted a need for improvement and I made the recommendation that an aSSKINg template was required in the electronic patient record to reduce the variations in care and improve documentation. 

A digital nurse specialist, a digital configuration analyst and I built the initial template. I identified six community nursing teams Tust-wide who wanted to participate in the pilot and the pilot started on the 6 February 2023. Alongside the pilot sites we made adjustments to the template.  Due to the overwhelming success of the pilot, I closed it on the 15 April. This is demonstrated in the table below. 

The feedback from the pilot site was that they found it helpful in that everything relating to pressure ulcers was in one place and they knew they had documented everything correctly. The Operational Leads fed back that they found it easier to locate information when completing clinical incident reports. 

Next steps

Following success of the pilot, the aSSKINg template has started to be rolled out Trust-wide. I decided, in discussion with other clinicians, that the roll out would be done gradually. The reason for this was to allow staff time to digest the changes and feel supported by the Practice Development Nurses, the digital team, their local tissue viability team and myself. 

Overall, the rollout is successful and teams are engaging with the change. There is a noted improvement in the overall documentation and early evidence that the variations in care are reducing. 

My advice to anyone thinking about doing something similar is to have good stakeholders involved, and to roll out a programme like the aSSKINg template care plan slowly as that has helped us to iron out any issues early on.

Have you implemented a new initiative in your organisation? Have you improved patient safety where you work? We would love to hear from you and share on the hub your journey. If you are a member, you can share directly on the hub or please contact content@pslhub.org to discuss further.

About the Author

Susan qualified as a Registered Nurse in 2001 and her first nursing job was at The John Radcliffe Hospital in Oxford.  She then moved to the South Coast and worked at Worthing Hospital before moving to community nursing in West Sussex. She has been a Tissue Viability Nurse Specialist for 7 years working in East Sussex.  Alongside her NHS job, Susan is also an honorary tutor at the School of Medicine, Cardiff University.