Shared learning database

Type and Title of Submission


Improving Pressure ulceration documentation pathways


The introduction of a primary care trust wide documentation system for the district nursing service to promote standardised assessment and management using best practice indicators for the management of pressure ulceration in community settings.


2010-11 Shared Learning examples

Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG29 Pressure ulcers - The prevention and treatment of pressure ulcers

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?


Description of submission


To facilitate standardised assessment across the trust using best practice guidance for patients vulnerable to or with current pressure ulceration. To facilitate an audit tool based on local essence of care bench marking that would measure documented care data against local / national standards and guidelines for patients requiring prevention and treatment of pressure ulceration.


To develop a system of documentation based on current best practice and available guidance to support the district nursing service to provide appropriate care to the local population.


Prior to this initiative there was no standardised pressure ulceration assessment documentation for the district nursing service. Patient assessment documentation did not meet the criteria set out in Standards for better health, Essence of Care, Care quality Commission, NSF and Nursing and Midwifery Council requirements.


2007/8 - Routine documentation audit identified poor wound documentation across the trust. Lack of consistency for assessment / documentation indicators within clinical teams: Best practice indicators were reliant on knowledge & experience of the individual practitioner. NICE guidance was not incorporated in a standard document to aid decision making. 2008/9 - A Relevant literature search identified best practice indicators and from this: - A district nurse training and education programme was developed. - Assessment documentation templates were developed. - Paper based incident reporting for all ulcers grade 2 and above instigated. - An equipment and medical devices pathway was developed. - Local documentation bench marking commenced with Greater Manchester Essence of Care Group (GMEC). 2009/10 - Documentation amended to incorporate additional guidance. - Tissue Viability training made mandatory across the trust. - Implementation of new wound care formulary and referral guidance. - Electronic incident reporting system implemented and mandatory. - Annual GMEC audit continued. - Internal record keeping audit by QUIPP leads. - Local Practice development mentors identified for all nursing staff. - Task and Finish group to identify equipment process and financial burden. - Action plan generated from the proposals from the task and finish group. 20010/11 - Incident panel meet weekly to ensure all reports are managed appropriately. - significant event analysis for all identified incidents is undertaken and lessons learned identified and cascaded to all relevant parties: - NHS Northwest and AQUA commenced in 4 key areas including pressure ulceration: - Monthly training calendar for all clinical staff developed. - Competency assessments for all nursing staff in development.

Results and evaluation

The NICE guideline recommendations have been incorporated into the Pressure Ulcer Assessment and equipment assessment documentation attached as supporting material. The district nursing service was initially resistant to change but following restructure of the service and implementation of practice development mentors change is happening. There was no additional cost apart from the time commitment of the Tissue Viability Service to promote best practice for patients that was standardised across the trust. The work in ongoing and evaluated annually in the GMEC audit and internal record keeping: Prevalence reports are to be collated in 2011. From current figures and estimations the number of EPUAP 2 has increased and EPUAP 3-4 decreased. This in part is due to the more accurate reporting. Equipment requests are now electronic with more accurate audit data. The NICE information booklet (N0913 1P2005) 'guidance for the public' is given to all patients and or relatives as part of the initial assessment process as recommended in the main NICE guidance, the quick reference guide and the GMEC criteria. Distribution of the public information booklet is documented in the individual patient's pressure ulceration assessment form and also in the three monthly equipment re-evaluation forms. A further question prompting discussion between patient / relative and the clinician appears in the main pressure ulcer assessment documentation. Audit data then confirms compliance. Of significant note is the (N0913 1P2005) 'guidance for the public' is only produced in English and Welsh which can be problematic as Trafford has such a diverse multi-cultural society mix. Ethnic minorities can therefore be disadvantaged through the lack of published national information.

Key learning points

The process of implementing clinical guidelines has to be continuous and flexible. The current assessment form already requires updating to include the MUST nutritional assessment. The pain evaluation tool also needs to be amended so the same tool is being used across all care settings. All Stakeholders need to be identified, accountable and involved at each stage. Audit process and bench marking against key quality indicators must be continuous to take account of new guidance and best practice indicators.

View the supporting material

Contact Details

Name:Sue Worsley
Job Title:Tissue Viability Nurse
Organisation:Trafford Provider Services
Address:Partington Health Centre
Postcode:M31 4FL


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This page was last updated: 03 February 2011

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.