Policy: Compassionate Care Team Ltd is committed to providing consistent, evidence-based quality care in the prevention, management and treatment of pressure ulcers for all Service Users. This will incorporate a holistic assessment and demonstrate Service User/carer involvement in the care provided.
A Pressure Ulcer Risk Assessment will be undertaken for all Service Users prior to the start of any care provision. The risk level will be documented in the Care Plan. Service Users who are identified as being at risk of developing pressure ulcers will have a detailed plan of care established. This will directly reflect NICE guidance for pressure ulcer prevention and management (2014).
Service Users identified as at risk should be informed and advised regarding prevention measures and strategies. Compassionate Care Team Ltd will, without delay, refer the Service User to the GP or Community Nursing Team for urgent assessment.
In the absence of a Service User's capacity to be involved, the Care Worker will make decisions in the Service User's best interest in accordance with the Mental Capacity Act (2005).
Where a pressure ulcer is identified, either on transfer from another care provider or at any time during the provision of care and support to the Service User, any concerns about skin integrity or the development of a pressure ulcer will be reported in line with local safeguarding procedures and a notification sent to the Care Quality Commission in line with statutory reporting requirements. All pressure ulcer occurrences will be investigated and lessons learned applied to ensure continuous quality improvement. In order for this policy to be effective the following is expected: • This policy and other best practice resources will be available to and for Care Workers on induction to Compassionate Care Team Ltd. This is in addition to ongoing training and support to maintain knowledge, skills and competence of managing skin care • There will be suitable, sufficient and well-maintained equipment available at Compassionate Care Team Ltd to meet and support the assessed needs of the Service User • Reporting of incidences will be in accordance with Compassionate Care Team Ltd's policy that incudes necessary reporting to the Regulator when required
Procedure: Contributory Factors Pressure and shearing are significant causes of pressure ulcers but there are factors that directly contribute to an individual’s overall risk of developing a pressure ulcer. A Care Worker supporting Service Users will be aware of these factors and how to implement strategies to try to minimise the risk. These include: • Decreased/impaired level of mobility • Sensory impairment • Incontinence • Level of consciousness • Acute, chronic and terminal illness comorbidity • Posture • Cognition, psychological status • Previous pressure damage • Extremes of age • Nutrition and hydration status • Moisture to the skin • Creased bed sheets • Tight clothing • Incorrectly used or inappropriate type of pressure relieving device
Pressure Ulcer Risk Assessment • All Service Users will be assessed for the risk of developing a pressure ulcer, by a suitably trained manager, using Compassionate Care Team Ltd's recognised risk assessment tool prior to care commencing • Formal assessment will guide Care Workers to identify those at highest risk of developing pressure damage. The Care Worker must be aware that it is the individual factors that raise the risk, not the overall score and therefore should introduce personalised strategies focusing on the identified risk factors and clinical judgement • Outcomes of risk assessments and agreed strategies will be documented in the Service User's CarePlan and will be communicated to other Care Workers to ensure that care is provided in accordance with assessed need • The Service User's skin condition will be assessed on every care intervention (e.g. personal hygiene, repositioning, toileting) and concerns identified will be immediately communicated to the senior Care Worker. The Care Worker must be able to identify, report and record the following skin conditions damage and is protected and monitored appropriately • Care Workers must use correct positioning, moving and handling techniques and equipment to minimise the risk of shearing
Categorisation • Pressure ulcers will be graded according to the European Pressure Ulcer Advisory Panel (EPUAP) Grading (2014) Pressure Ulcer Grading Tool • If a Care Worker is in any doubt about the correct categorisation of a wound, a second opinion should be sought from a Registered Nurse e.g. the District Nurse • With regard to record keeping, pressure ulcers should not be reverse graded. A grade 4 pressure ulcer does not become a grade 3 as it heals. As the ulcer heals it should be described as a healing grade 4 pressure ulcer • Body maps and photographs (with Service User's consent) of any pressure damage must be documented and a specific wound care plan implemented. Compassionate Care Team Ltd should be aware of their Data Protection responsibilities where photographs are taken • Compassionate Care Team Ltd should refer to the Royal Marsden Manual of Clinical Nursing Procedures for current recommended practice
Therapeutic Equipment Pressure reducing surfaces or devices are used to reduce and redistribute the overall pressure to the vulnerable bony prominences, such as the sacrum (bottom of the spine), hips, buttocks and heels (NICE 2014). • Following an assessment by the district nursing team or tissue viability specialists, Service Users at high risk of developing pressure ulcers may be assessed as requiring a pressure redistribution mattress. The type of device a Service User needs will depend on their circumstances, mainly: 5.7 Reporting • Cases of single category/grade 1 and 2 pressure ulcers must be considered as requiring early intervention to prevent further damage. If there are concerns regarding poor practice, it should be escalated and recorded as a clinical incident in line with local safeguarding procedures and a statutory notification made to the CQC • Pressure damage grade 3 and 4 will be reported to the local safeguarding teams and the Regulator. This will be for all pressure ulcers including those that may develop in other settings • To support learning and reflection, Compassionate Care Team Ltd will complete a root cause analysis investigation for any home-acquired pressure damage grade 3 or 4 • For Service Users who present with a grade 3 or 4 ulcer, or deteriorating pressure ulcer, an urgent referral to a specialist support professional (e.g. tissue viability nurse) will be made for advice and guidance • All incidents of pressure ulcers should be recorded internally, investigated and a root cause analysis conducted to improve care practice. Staff should be made aware of the findings in line with Compassionate Care Team Ltd's audit procedures • Where a Service User transfers from another care setting (e.g. hospital or respite) or from another care provider and develops any category/grade 3 or 4 pressure ulcer within 72 hours, it must be escalated and reported to the previous care provider as a clinical incident and Compassionate Care Team Ltd must follow their own safeguarding and regulatory reporting procedures