This month I was lucky enough to travel to Malta with OSKA. Here I held a Pressure Ulcer Prevention Workshop with the wonderful nurses from both the community and hospital, and some allied health professionals who attended also.
Through this training, the nurses and Occupational Therapists were interested in how we prevented pressure ulcers in the United Kingdom and the National strategy of aSSKINg, react to red and our training content in line with guidelines and policies.
Throughout delivery of this training I also discussed themes around our root cause analysis discussing our challenges as well as our successes. It was in this part of the training workshop the Tissue Viability Nurses became most animated in our discussions.
With the same patterns and themes around these challenges experienced in the United Kingdom it made me reflect on just how international these similar challenges are. The nurses’ and AHPs’ feedback was they were delighted to hear that we, in the UK, also face similar challenges, and this made them feel relieved they were not alone in facing these challenges.
We all reflected on how in parts of our career it hasn’t always been easy to share our challenges, especially where the solution is not always clear. An example of this was the high use of agency staff and turnover in nursing staff which for a small island like Malta, I myself was surprised. However, on advice of the Malta nurses I was told that there are as many nurses immigrating as emigrating in to Malta and other places of the world. As a result, continued training and understanding of early identification and categorising of pressure ulcers continues to be a very large challenge.
For any wound care professional this will not be a surprise as the research has identified that nurses have poor Inter/Intra- rater reliability of categorising, meaning one nurse may think a wound is categorised as say a category 2 and another may categorise it as a category 3 and another as a moisture lesion.
Long-term care settings know that this is not a new issue as they are in some cases reliant on district nurses in correctly categorising a pressure ulcer, however we know that this is extremely challenging depending on the level of experience. Research looking at interrater reliability shows that the more experienced the nurse, the less discrepancy in categorising there is. However there are still discrepancies at senior levels, myself included throughout my career has needed many a second opinion for reassurance and validity! Those that know me know how I share my experience of when I first diagnosed a ‘red area’ as a moisture lesion as a carer and how that journey led me to what I do today (if you want me to share again just ask as really was the beginning of my journey in patient harm and quality improvement).
As we reflected and discussed on this the nurses agreed that, okay the research demonstrates this, however how do they transcribe this to improvement in practice, how do we mitigate this in reality?
These are very real discussions in pressure ulcer prevention we may all know the challenges such as shortness of staff, lack of training in multidisciplinary teams, lack of public awareness of what a pressure ulcer is, lack of domiciliary care training et cetera. Finding solutions to these issues cannot be done in isolation and support is needed from frontline staff and strategical staff alike with a shared vision. Actions need to be broken down to smart goals as the struggle to work on all of the improvement plans cannot be done alone.
With a wealth of organisations increasingly sharing their successes & innovations, for some it can seem a long-distance path.
This trip to Malta and discussions with the nurses identifying similar themes to the UK has made me reflect how important it is to share our challenges as well as successes. This can and may include our culture or barriers to change implementation. How we do this may be complicated if there is a poor organisational culture, we may not feel supported in sharing these barriers with the wider world.
We can copycat organisations that have had good successes in a pressure ulcer prevention programmes, however without a positive culture and leadership, implementing this in our workplace may not be as effective.
Where organisations can share their challenges more openly from preventable harms this may start to create long-term meaningful changes leading to a reduction in their patient harms.
When I started involving my patients more in investigations of their pressure ulcer, they in turn would be an expert by experience, and although at times uncomfortable in bearing full transparency in the gaps of care they were also able to offer ‘outside of the box’ thinking and suggestions that then supported our programme prevention in the longer term.
We may share this experience in-house within our own organisation, however it is these experiences that need to be shared to a wider audience, as it is clear that the challenges I faced as one wound nurse in one demographic area in the UK may be the same for another wound care nurse thousands of miles away.
How we do this again needs to be shared, there are a lot of models on duty of candour, share and learn and transparency models which can be researched. How can this be utilised in practice with wound nurses across the world?
Link in to #stopthepressure or come on to the closed Facebook page and ask your international peers.
Those that have not been to Malta I strongly recommend it as a UNESCO world Heritage site, steeped in history, very friendly people and is on the Mediterranean Sea. What more could you ask for?! Thank you for having me!
