Abstract

Background
Pressure ulcer risk assessment tools play a pivotal role in meeting the challenge of the zero pressure ulcer agenda. Clinicians should use their clinical judgement in combination with a validated pressure ulcer assessment tool when detecting and managing patient pressure ulcer development risk. The assessment tool, therefore, should effectively, and reliably direct pressure relieving equipment resources. This is particularly important when considering the influence of the pressure ulcer assessment tool on patterns of care and allocation of resources.

Aim
To undertake a service evaluation and identify a quality improvement opportunity, surrounding pressure ulcer assessment, prevention, and care practices within one community health services NHS Trust.

Method
An online questionnaire was purposed-developed to capture the perceptions and experiences of the Trusts clinicians surrounding the assessment, prevention, and management of pressure ulcers using the Waterlow pressure ulcer risk assessment tool. Questionnaire content was developed in collaboration with a panel of Trust employed healthcare and research experts. Data analysis adhered to the principles of an inductively informed six-phase recursive Thematic Analysis.

Results
Two interrelated themes reflected the clinicians' perceptions and experiences: Confidence in Waterlow Supporting Clinical Decision-Making and Defensively Nursing. Some perceived Waterlow as useful, although flawed tool. Others perceived the use of Waterlow to have negatively influenced working practices by developing 'nursing by numbers' care practices and a propensity for over-prescription of pressure relieving resources.

Conclusion
The results provide important elucidation surrounding pressure ulcer care practices and provide evidence to support quality improvement innovation within the Trust.