Evaluating & Innovating the Pressure Ulcer Risk Assessment

Green, Heidi A., Longstaffe, Colette, Wiseman, Janice and Jackson, Christine (2017) Evaluating & Innovating the Pressure Ulcer Risk Assessment. In: Tissue Viability Society Conference, 5th-6th April 2017, Birmingham UK..

Evaluating & Innovating the Pressure Ulcer Risk Assessment
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Item Type:Conference or Workshop contribution (Presentation)
Item Status:Live Archive


Current clinical, assessment, prevention and management strategies using Waterlow were closely examined and innovation was implemented.
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.
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.
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.

Keywords:Pressure damage, Pressure ulcers, clinical assessment tool, service evaluation, Waterlow, PURPOSE-T
Subjects:B Subjects allied to Medicine > B710 Community Nursing
L Social studies > L990 Social studies not elsewhere classified
B Subjects allied to Medicine > B990 Subjects Allied to Medicine not elsewhere classified
B Subjects allied to Medicine > B700 Nursing
Divisions:College of Social Science > School of Health & Social Care
ID Code:48123
Deposited On:22 Feb 2022 16:09

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