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Right Patient, Right Mattress, Right Time

Posted on March 13th 2018

This is the web version of the clinical trial that was first published in PDF format on this page.  


Working in partnership with the Clinical Nurse Advisor to achieve - Right Patient, Right Mattress, Right Time

Written by Karen McKay (Clinical Nurse Advisor) & Carrie McCulloch (Senior Nurse Tissue Viability)

Introduction

The NHS is having to maintain pace with the complexities of care patients require and the increasing demands on resources. The tolerance for waste is no longer palatable for any healthcare provider with every effort being made to target resources swiftly and appropriately.

Despite all of the efforts generated, the occurrence of pressure ulcers remains a huge challenge for those working in healthcare1. The provision of specialist mattresses has a significant role to play as one of the key critical interventions in the prevention and management of pressure ulcers. The introduction of any specialist piece of equipment would be subject to a full risk assessment including inspection of the individual’s skin and grading of pressure damage2.

Within NHS Lanarkshire Drive DeVilbiss Healthcare provides a Clinical Nurse Advisor (CNA) to review specialist mattress utilisation and support compliance with mattress prescription criteria. It was agreed to review this role to demonstrate how nursing leadership and collaborative working with industry colleagues has a positive influence on patient care and maximises financial control.

Appraisal of the current mechanisms identified that although there was a large quantity of data provided by the CNA, there was no formal commitment to progress or action any issues identified. Despite efforts by the CNA, there was a lack of engagement with the identified results. Issues such as increasing costs were seen as a Tissue Viability problem, despite having measures in place to monitor equipment utilisation, identify wastage and ensure appropriate usage.

Method

The CNA and Senior Nurse for Tissue Viability recognised the importance of strong collaborative working relationships based on trust, commitment and accountability. They believed the work they were undertaking had to make a difference to patients. The current situation in relation to the provision of mattresses was reviewed to identify ‘does every patient, have the right mattress for the right period of time?’

The CNA established a number of monitoring mechanisms including;

  • Identifying mattresses in use on acute sites
  • Identifying unnecessary mattress usage
  • Monitoring mattresses in the community
  • Monitoring the use of mattresses in care homes

It was agreed the current position was not optimum in terms of safe and effective care or resource management. The mechanisms could be improved, but without buy-in from clinical and senior staff within hospital and community sites, any initiatives to improve outcomes would be unlikely to succeed3.

The Senior Nurse and CNA implemented joint Ward Audit Visits. This was then clarified in report format and shared with key personnel including site teams and the TVN team.

The Senior Nurse restructured team meetings to ensure the CNA could highlight her report findings. Ideas were then generated to improve compliance with mattress utilisation. Following feedback changes were made to the way reports were communicated with the aim of encouraging engagement at ward level and actioning the findings.

Pulled quotes from article: "Right Patient, Right Mattress, Right time"

Results

The CNA resource provides clinical advice on mattress selection and valuable service support. The role requires flexibility and an ability to collaborate with multiple team members. A key focus of the role is to establish and maintain strong relationships with the contract provision and provide local information, advice and guidance.

The CNA works closely with clinical staff ensuring that all mattresses are prescribed appropriately. Increasing the credibility and visibility of the CNA with staff teams, made a positive impact on accurate patient assessment in regard to support surface needs.

Discussion

In this instance, the CNA works solely within the Health Board contract. The healthcare industry has matured significantly in becoming a genuine partner and there is now a common goal that exists which is to provide better outcomes for patients4.

Conclusion

The CNA role is now recognised as a valuable resource for educational support, problem-solving and monitoring of utilisation and wastage. The CNA is actively involved in the Tissue Viability Workplan and is a key part of the educational element of the service.

The CNA should be fully included in both the Tissue Viability Team and Acute and Primary Care Teams to have a beneficial impact. Working collaboratively with industry colleagues has a positive influence on patient care and maximises local financial control.

There is now confidence that mattress utilisation is of the best possible value with an elimination of waste. As a result, the Contract Monitoring team is assured that each dynamic mattress is warranted and wastage is vastly reduced.

Results and conclusions from artcile: "RIght Patient, Right Mattress, Right Time"

 

References:

  1. (Fletcher 2015) Fletcher Pressure ulcer management: How to guide. Wound Essentials 2012;7(1):1-4
  2. (NHS Education for Scotland 2015) Learning Outcomes - NHS Education for Scotland HYPERLINK “http://www.nes.scot. nhs.uk/media/281465/los_tv_workbook.pdf” www.nes.scot.nhs. uk/media/281465/los_tv_workbook.pdf
  3. (French Bravo et al 2014) Shared Governance: The Role of Buy-in in Bringing About Change Matthew French-Bravo, MSN, RN; Gregory Crow, EdD, RN OJIN Vol 20 2015 No2 May 2015
  4. (Alcorn and Jarrad 2013) NHS. SSKIN: Five simple steps to prevent and treat pressure ulcers. http://nhs.stopthepressure.co.uk/SSKIN/sskin.htm.
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Right Patient, Right Mattress, Right Time