Improving individual patient experience by implementing a review of support surfaces currently in use by long term patients in the community setting.
NICE quality statements relate to patient experience and safety issues. Ensuring that care is safe and that people of all ages have a positive experience of care is vital in a high-quality service. It is important to consider these factors when planning and delivering services in the community.
NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (CG138), which should be considered alongside the quality standard (QS89). Both specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and are supported to understand their options and make fully informed decisions.
Funded by the CCG an equipment nurse was employed to carry out individual patient assessments in order to review current prescribing of pressure redistributing support surfaces in the St Helens and Halton localities in line with NICE Quality Standard QS89 2015.
The development of a pathway for the prescription of pressure redistributing equipment and a patient information leaflet ensured patient involvement was achieved throughout the review process. The equipment review, carried out with 417 individual patients in their own homes, identified inappropriate prescribing of pressure redistributing equipment in relation to individual requirements. A number of patient case studies were gathered to assist clinicians to understand the importance of patient choice and involvement in a long term community setting.
Patient Case Study A - A 54 year old gentleman was reviewed by the Equipment Nurse Specialist who currently was prescribed a dynamic mattress. The gentleman spent just 6 hours on his bed in a 24 hour period, was able to reposition himself independently and had no existing or previous pressure damage. Patient A’s main concern was that he was given the mattress on his discharge from hospital four years ago following a stroke that left him with a right sided weakness; he was informed by hospital staff that he would be on the mattress for life as this was the only way to protect from pressure ulcers. After discussion with the patient and educating him on pressure area management he agreed to change the mattress to a high risk foam.
At follow up the patient explained he had no issues with the static foam and was wondering if he could he just have a "normal mattress" The gentleman wanted to be able to share a double bed with his wife again, so advised them on commercial pressure reducing mattresses available, agreed with the Tissue Viability Team. The patient was able to go back to a double bed with his wife after 4 years.
Patient Case Study B - Patient B was a 78 year old male with dementia living at home with his wife who was his main carer. I arranged to assess Patient B as he had a dynamic mattress system. On my arrival the hospital bed and mattress were situated in the living room, patient B was able to transfer to his reclining chair in the day time with the help of his wife and a patient turner, the mattress was in place from his last hospital admission following deterioration in his condition.
After speaking to his wife and assessing the patient it was decided that the dynamic mattresses was not required and he could be ‘stepped down’ to a high specification foam, His wife was "so relieved". She had moved her husband into the living room as she "couldn’t sleep with the noise of the mattress". Prior to the dynamic mattress being provided she had the hospital bed in the bedroom so she could sleep next to her husband, I changed the dynamic mattress to a high risk foam. Telephone review was completed 4 weeks after initial assessment and the patient was now back sleeping next to his wife.
These case studies provide evidence of the importance of patient involvement and comfort, from the perspective of patients who are prescribed a pressure redistributing support surface as part of their pressure ulcer prevention and management plan. It highlights that the support surface provided in the community greatly impacts on patients general well-being as the support surface needs to fit in with everyday needs on a long term basis.
Patients in the community are provided with a broader assessment of their needs in relation to support surfaces in order to maintain their general well-being, comfort and personal relationships on a long term basis.
Lucy Welding - Equipment Nurse Specialist