Introduction: Pressure ulcers (PUs) cause pain and discomfort, reduce quality-of-life and can prolong hospital admissions. Their debilitating complications have the potential to exacerbate the high mortality and morbidity associated with hip fracture. Introducing innovative and sustainable strategies is vital to promote high-quality services for patients.
One of the British Orthopaedic Association six national standards for hip fracture care states that ‘All patients with hip fracture should be assessed and cared for with a view to minimising their risk of developing a pressure ulcer’.
Change strategies: In 2010, we reviewed local incidence of grade 2 and above PU compared with national average using the National Hip Fracture Database. Trust average was 7% and national average 3.9%. In December 2010, a 6-month project was undertaken by a multidisciplinary working team. We undertook root cause analysis of all patients who developed grade 2 and above PU. Utilising these findings a best practice guideline and education session was developed.
Change effects: All the patients placed on alternating dynamic air mattresses within X-ray immediately following diagnosis. Education session to accompany the best practice guideline delivered to 57 orthopaedic MDT staff. Initial audit 2010 prior to the project 10% of the 191 patients developed a PU. Post-intervention re-audit 2011 showed 4% of the 170 patients developed a PU, demonstrating a reduction of 60%. Fisher's exact test: P-value = 0.041. Two proportion t-test = 0.028. 2011–12 PU development is 0.9% against a national average of 3.7%. This highlights a sustainable and on-going reduction of 87% since the commencement of the project.
Conclusion: The development of this local innovation has demonstrated a remarkable reduction in the development of pressure ulcers. The continuous audit cycle has enabled the effects to be closely monitored against local and national standards and its impact sustained.