Pressure Ulcer and Wounds Reporting in NHS Hospitals in England Part 1: Audit of Monitoring Systems

Article English OPEN
Smith, IL ; Nixon, J ; Brown, S ; Wilson, L ; Coleman, S (2016)
  • Publisher: Elsevier
  • Journal: Journal of Tissue Viability, volume 25, issue 1, pages 3-15 (issn: 0965-206X)
  • Related identifiers: doi: 10.1016/j.jtv.2015.11.001
  • Subject: Dermatology | Pathology and Forensic Medicine

Internationally, health-care systems have attempted to assess the scale of and demonstrate improvement in patient harms. Pressure ulcer (PU) monitoring systems have been introduced across NHS in-patient facilities in England, including the Safety Thermometer (STh) (prevalence), Incident Reporting Systems (IRS) and the Strategic Executive Information System (STEIS) for serious incidents. This is the first of two related papers considering PU monitoring systems across NHS in-patient facilities in England and focusses on a Wound Audit (PUWA) to assess the accuracy of these systems. Part 2 of this work and recommendations are reported pp *-*. The PUWA was undertaken in line with ‘gold-standard’ PU prevalence methods in a stratified random sample of NHS Trusts; 24/34(72.7%) invited NHS Trusts participated, from which 121 randomly selected wards and 2239 patients agreed to participate. Prevalence of existing PUs: The PUWA identified 160(7.1%) patients with an existing PU, compared to 105(4.7%) on STh. STh had a weighted sensitivity of 48.2%(95%CI 35.4%-56.7%) and weighted specificity of 99.0%(95%CI 98.99%-99.01%). Existing/healed PUs: The PUWA identified 189(8.4%) patients with an existing/healed PU compared to 135(6.0%) on IRS. IRS had an unweighted sensitivity of 53.4%(95%CI 46.3% to 60.4%) and unweighted specificity of 98.3% (95%CI 97.7% to 98.8%). 83 patients had one or more potentially serious PU on PUWA and 8(9.6%) of these patients were reported on STEIS. The results identified high levels of under-reporting for all systems and highlighted data capture challenges, including the use of clinical staff to inform national monitoring systems and the completeness of clinical records for PUs.
  • References (40)
    40 references, page 1 of 4

    [1] Shojania KG, Marang-van de Mheen PJ. Temporal trends in patient safety in the Netherlands: reductions in preventable adverse events or the end of adverse events as a useful metric? BMJ Qual Saf 2015 [online first].

    [2] Baines R, Langelaan M, de Bruijne M, Spreeuwenberg P, Wagner C. How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time. BMJ Qual Saf 2015;24(9): 561e71.

    [3] Vincent C, Amalberti R. Safety in healthcare is a moving target. BMJ Qual Saf 2015 [online first].

    [4] Baines RJ, Langelaan M, de Bruijne MC, Asscheman H, Spreeuwenberg P, van de Steeg L, et al. Changes in adverse event rates in hospitals over time: a longitudinal retrospective patient record review study. BMJ Qual Saf 2013; 22(4):290e8.

    [5] Shojania KG, Thomas EJ. Trends in adverse events over time: why are we not improving? BMJ Qual Saf 2013;22(4): 273e7.

    [6] Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 2010; 363(22):2124e34.

    [7] Tanner J, Padley W, Kiernan M, Leaper D, Norrie P, Baggott R. A benchmark too far: findings from a national survey of surgical site infection surveillance. J Hosp Infect 2013;83(2):87e91.

    [8] NHS-England. Understanding the new NHS. London: N. E. Medical Directorate; 2014.

    [9] DH. An organisation with a memory. DH. Norwich: Stationary Office; 2000.

    [10] DH, Building a safer NHS for patients: implementing an organisation with a memory, DH. London: Department of Health.

  • Similar Research Results (1)
  • Metrics
    No metrics available
Share - Bookmark