Abstract

Background
Current clinical, assessment, prevention and management strategies using Waterlow were closely examined and innovation was implemented.
Methods
Staged, service evaluation. Stage-One, clinician’s perceptions and practice surrounding pressure ulcer (PU) assessment, prevention and management using Waterlow explored via purpose-designed questionnaire survey. Stage-Two, the Trust, became early adopters of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T)[1]. Stage-Three, a focus group obtained five Clinical Nurse Specialists (CNS) perceptions surrounding PURPOSE-T.
Results
Stage-One survey thematic analysis[2] identified two interrelated themes Confidence in Tool Supporting Clinical Decision Making and Defensively Nursing. Some considered Waterlow a useful, but flawed tool. Others considered Waterlow risk over estimation propensity and associated protocols resulted in a constrained dictation and organisational pressure to prescribe PU relief equipment. This seemingly had influenced a working culture where clinical judgement is (for some) overruled by Waterlow score outcome and ‘nursing by numbers’ care. Many directly requested Waterlow replacement. In Stage-Two PURPOSE-T was successfully integrated into SystmOne and clinical routine. Stage-Three Thematic analysis[2] identified two themes surrounding PURPOSE-T, A More Meaningful Assessment and Usability in Practice. Patient screening was considered important for improving patient care and enhancing decision-making. Comprehensiveness of PURPOSE-T assessment was instrumental in developing clinical decision-making confidence. PURPOSE-T was considered easy to use; the use of risk factor colour associations was limited by SystmOne functionality.
Discussion
Stage-One captured diverse clinical perspectives. Working practices identified in Stage-One reflect serious and expensive limitations. PURPOSE-T was considered to support a more meaningful assessment approach, that could potentially improve resource allocation and deliver Trust cost savings.
Clinical Significance
The findings provide robust evidence that PURPOSE-T is a suitable replacement for Waterlow across the Trust.