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Long Term Care guide to working with community and acute nursing teams to prevent pressure ulcers

Coming from a community background as a carer, community nurse, tissue viability nurse and pressure ulcer prevention lead, I have spent most of my career sitting in and leading on complex MDT meetings. Through assessment, admission, safeguarding and investigation the consistent emerging theme was on the importance of communication and cross organisation working.

We know this can be a challenge without a unified data system accessible by all services (seriously how has this not happened yet!).

Although we are told to work together this can be difficult to co-ordinate, see below some practical tips to try to get this going:

  • Do you see a District Nurse or Tissue Viability Nurse? Ask them if they’re using a standardised prevention plan e.g. SSKIN – Can this information be shared with you and the resident? This should be happening as standard but it does depend on level of engagement you have with the nurses.
  • Can you share electronic NHS care plan access? This would be a question to take back to your home manager to ask if in the pipeline. Many homes are now getting access to System 1 or Rio the GP records system, with limited access to relevant care plans and updates.
  • Is there someone working in your local CCG or NHS series in harm prevention? Would you like to work with them on a small project, for example, looking a rates of moisture lesions within your home? There is a real need for this and the local continence nurse specialist may be able to support you with this. Then why not publish your findings?
  • Are there MDT meetings regarding residents and can you ask to attend these? Especially if you are closely involved with the resident asking to follow up their care needs may give you some ideas on any improvements.
  • MDT safeguarding meetings. How many times have I heard a care home get frustrated where a new admission with a complex pressure ulcer have received a referral but not an invite to the discharge planning meeting. This is up to the individual home leads to pursue their local relationship with discharge leads, however you may be happy to deputise to this role and sure your manager will be happy for the offer. 
  • Acquired investigation of a pressure ulcer. So you have a newly acquired PU in the home which has been referred to CQC and an investigation (Root Cause Analysis) is to follow. Firstly do not panic! Remember even if gaps are found it is rarely down to one individual, rather it is an organisational gap. Actions set from these incidences should be meaningful and measurable not a tick box exercise. Again, being involved in this process although may seem daunting is where real positive change can start, so don’t be worried in asking to be part of this as a MDT process. For example if you felt the communication between the home and the community staff could have been better, say this! If you work together to find solutions this can be effective in protecting further residents and improving relationships with your community colleagues.

In an ideal world for our very complex residents having home ‘bedside’ MDT meetings involving the patient or LPA and multi- services on agreeing plan is most preferred. This can be a challenge to organise but if you have a good admin team or interested champion such as yourself, it is a case of co-ordinating diaries. Where you have the TVN, Resident, Care home staff, Physio, OT in a room together is likely to be a better PU prevention plan for complex needs.

For example I was involved in a case where an OT had prescribed a fabulous rise recliner chair which was built around the ergonomics of the residents anatomical position. However when the gentleman was admitted, then later discharged from hospital, he had lost weight and his anatomical position in the chair had changed. As a result part of his specialist chair was now digging into his hip and he went on to develop a Category 4 pressure ulcer. As a result this prompted some work on joint MDT therapy and nursing projects to make improvements.

As health and social care professionals we have the same mission to provide the best care for our patients and residents. We can get in a pattern of working in silos and providers need practical tips on ways of joint working.

If you have been involved in any work in the above and would like to share your challenges and/or success please come on to the champion network facebook page as you may inspire others and #stopthepressure. For any other information contact OSKA.