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Click on the headings below to read more about each resource. 1. Skin Assessment: Assessing skin on patients with darker skin tones in relation to PU prevention In this 56 minute presentation by The Society of Tissue Viability, Jacqui Fletcher looks at how wound care and pressure ulcer prevention can be improved for patients with darker skin tones. 2. Guys and St Thomas' Stop The Pressure pledge wall As part for their #STOPthepressure 2022 awareness campaign, Guys and St Thomas' started a pledge wall for all staff to contribute to by making a personal pledge. Their goal is to foster a culture that aims to eliminate avoidable pressure ulcers. 3. Wounds UK: Best Practice Statements Wounds UK have developed a number of Best Practice Statements, designed to help clinical staff improve wound care. These include: Active treatment of non-healing wounds in the community Addressing skin tone bias in wound care: Assessing signs and symptoms in people with dark skin tones Care of the person with diabetes and lower leg ulcers Post operative wound care: reducing the risk of surgical site infection 4. Helping to prevent pressure ulcers: A quick guide for registered managers of care homes (NICE) Pressure ulcers can be serious and lead to life-threatening complications, such as blood poisoning and gangrene. However, taking some simple steps can reduce the chance of pressure ulcers developing. NICE has produced a quick guide for care home managers. 5. Taking photos of pressure ulcers In the latest Sussex Community Patient Safety newsletter, staff highlight the importance of photography in wound care and assessment. 6. Embedding skin tone diversity into undergraduate nurse education: Through the lens of pressure injury This study, published by the Journal of Clinical Nursing, explores health disparity in on-campus undergraduate nurse education through the analysis of teaching and teaching material exploring pressure injuries. 7. Measuring standards of care, not negative outcomes (Interview with Head of Nursing Quality) In this interview, Head of Nursing Quality Gavin Porter talks about his positive, team-focused approach to improving pressure ulcer outcomes. "Counting the number of pressure ulcers doesn’t really tell you about the standards of pressure ulcer care. I wanted to look at things differently; to focus more on the interventions and good practice that helps keep patients safe." 8. Sign up to safety - pressure ulcers (Barts Health NHS Trust) In this six minute video, Barts Health NHS Trust explains the measures frontline medical staff can take to help avoid the risk of pressure ulcers using the SSKIN acronym. 9. This Is Nursing podcast: We don't want a good wound. We want to prevent them! Alison Schofield, Tissue Viability Clinical Nurse Specialist, discusses the challenges facing her role in this current world of nursing, the impact of COVID-19 has had on the delivery of community tissue viability services and on people in receipt of the services in care homes and in their own homes. 10. Pressure Ulcer Path: prevent and treat step by step (NHS Midlands and East) Research has shown that frontline staff understand the dangers of pressure sores but experience significant challenges in their attempts to prevent them. NHS Midlands and East has created the Pressure Ulcer Path, a tool to support staff in preventing pressure ulcers and treating them, alongside a number of useful resources. Do you have a resource or story to share on pressure ulcer care or prevention? Our hub is designed for frontline staff, patients, managers, and anyone else else with an interest in patient safety, to come together and share their insights. You can sign up today for free for full access to our library of resources and all of the benefits on offer to our members.

This conference focuses on the prevention and management of pressure ulcers including monitoring, reporting and improvement and will focus on Learning from the Inaugural National Pressure Ulcer Prevalence and Quality of Care Audit and reflecting on the challenges of Covid-19. The conference will open with National Developments from the National Wound Care Strategy Programme, learning from the inaugural Stop the Pressure: National Pressure Ulcer Prevalence and Quality of Care Audit and understanding Pressure Ulcers and Covid-19. The conference will continue with a focus on training and educating frontline staff, and an extended masterclass on Pressure Ulcer Assessment, Reporting & Management. Register

This conference focuses on the prevention and management of pressure ulcers including monitoring, reporting and improvement and will focus on Learning from the Inaugural National Pressure Ulcer Prevalence and Quality of Care Audit and reflecting on the challenges of COVID-19. The conference will open with National Developments from the National Wound Care Strategy Programme, learning from the inaugural Stop the Pressure: National Pressure Ulcer Prevalence and Quality of Care Audit and understanding Pressure Ulcers and COVID-19. The conference will continue with a focus on training and educating frontline staff, and an extended masterclass on Pressure Ulcer Assessment, Reporting & Management. Register

A year ago, you implemented a new approach to auditing at Barnsley. Can you tell us what prompted it? In healthcare, we tend to measure safety by looking at negatives. The number of falls, the number of category 2 pressure ulcers, the number of adverse events etc. Our whole system is built on it, from local auditing and Datix reporting, to CQC inspections. But counting the number of pressure ulcers for example, doesn’t really tell you about the standards of pressure ulcer care. I wanted to look at things differently; to focus more on the interventions and good practice that helps keep patients safe. Where did you start? We started with pressure ulcer reduction. Our Tissue Viability team and I looked at the learning from Root Cause Analyses and worked together to create a list of all of the things we can do to help prevent pressure ulcers. Skin assessments, pillow positioning, moving patients etc. If we ticked every box for every patient, would we prevent pressure ulcers altogether (unless the patient doesn’t follow the advice)? I took this list and worked with the digital app company, Perfect Ward to build a simple-to-use auditing tool. It allows us to measure safety by our standards of care and interventions rather than counting negative outputs. If our standards of care are high and a lot of people are still getting pressure ulcers, we have assurance on the standard of care being delivered. How did you implement the pressure ulcers audit? Once we had created the list of standards and preventative measures, we used the app to do an audit of around 35% of patients on each ward. At the start of the project, we found that teams were on average hitting 64% of the standards. The digital app provides a performance rating system, with red with red (less than 70%), amber (greater than 70% but less than 90%) and green (90% or more). The performance of the team against these ratings dictate how we would support each team moving forward. For example, if an audit showed a team to be performing at the lowest level (red), we made a commitment to support them on a weekly basis until they were performing at the highest level (green). How have staff responded? Staff have responded really well. This system provides recognition, and credit where credit is due. It can help staff to feel confident when they are providing high standards of care and to know that they are doing the right thing for the patients. Where there is room for improvement, the Perfect Ward app makes it is easy to see where the gaps in the delivery of interventions exist so they can be tackled. The tissue viability nurses are there to support, coach and to help problem solve. There may be certain interventions that are consistently missed which can sometimes be a sign that the wider organisation needs to help solve the issue. Safety is a shared responsibility, and we need to make sure we have the systems in place to support success. What support have you needed along the way? It’s really important to have passionate people who understand and believe in this approach to auditing. You need to have an Executive Team who are prepared to look at measuring outcomes differently. I’m lucky, our Director and Deputy Director of nursing are very supportive. It’s also important to acknowledge that it is not a silver bullet; change takes time. That can be frustrating for some people who want to see results quickly. It’s taken a year but teams are now hitting on average 94% of the standards set out by the auditing tool, and we are starting to see decreases in category 2 pressure ulcers (per 1000 bed days) since June 2020. What have you learnt? It has been really important to constantly engage staff and build good relationships, to make sure we understand everyone’s competing priorities. The approach has been a great enabler for quality improvement methodology, empowering teams to find their own solutions and really own the results. What’s next? This approach to auditing is not rocket science. It can be used to raise standards of care in most circumstances within health and social care – without focusing on the negatives. We have successfully applied it to both pressure ulcer and falls prevention at Barnsley and just started on nutrition and hydration. In the future I’d like to see it used in other areas, to identify what excellent dementia care in hospitals looks like for example. It could also be used to ensure that staff have a good understanding of the Mental Capacity Act and safeguarding processes. Or to make sure patients are being well-fed. It really is just a blueprint that can be used to raise standards of care, and safety in any circumstance. Final thoughts? I personally don’t like to look at my work as reducing harm. I prefer to look at it in terms of improving the standards of care we give our patients. The difference is important. Photograph of the Tissue Viability Team. Above is an example of a checklist used for pressure sores. The graph above shows the trust average on delivery of the pressure ulcer prevention interventions across adult inpatient wards over a 12 month period. The 'distribution of score' graph above shows the percentages scored across the adult inpatient wards for each month over a 12 month period. This graph shows more areas achieving 90% (or more) and fewer scoring 70% or less as time has progressed.