Implementation of an Equipment Nurse Specialist role to improve the current local guidance, train district nursing teams and carry out a review of the dynamic mattresses in the community setting to ensure provision of appropriate equipment to meet their needs
There is a variance in the confidence and skills for the prescription of equipment within District Nursing teams. This leads to disparity in equipment provided to patients. NICE Guidance CG179 (April 2014) indicates a step up and step down approach to provision based on clinical need. Reports from the equipment service indicated a high usage of high risk products. NICE guidance indicates that these should only be used in a minority of cases.
Funded by the CCG a number of coordinated activities were carried out as part of a project which ran from October 2015 to June 2016.
A self-evaluation review of skills and knowledge in regard to pressure redistributing devices and implementing the NICE pathway CG179 was carried out by District Nursing teams in order to develop a training programme for staff who prescribe pressure relieving equipment. The identified outcome was to develop a standard across the health economy and to develop a clear pathway throughout primary /acute care for the prescribing pressure relieving mattresses in line with NICE guidance.
An Equipment Nurse with clerical support was employed to audit current prescribing of dynamic pressure relieving mattresses and compare them to prescribing trends following introduction of the pathway and training programme. The number of dynamic systems prescribed to individual patients in the St Helens and Halton localities and those stepped down to static systems following patient assessment were documented. The aim of this service is to ensure an effective, efficient and appropriate use of pressure relief equipment in line with NICE guidance pathway CG 179 April 2014.
The development of a pathway for the prescription of pressure relieving equipment and a patient information leaflet to ensure patient involvement was achieved throughout the process. The audit identified inappropriate prescribing of pressure relieving equipment. Equipment ordered was the highest specification and as patient’s condition improved, equipment was not being stepped down accordingly.
The new equipment selection pathway was designed to aid, along with clinical judgment, the selection of equipment in line with the patient’s requirements. On the reverse of the tool there is further information on commercially available mattresses that also have pressure redistributing properties to help the clinician assess whether the patient’s own current mattress is suitable and provide for further potential cost saving in the prescription of pressure relieving equipment.
Since incorporating the new training, selection guide and equipment audit a reduction in inappropriate equipment has been evidenced with a saving of £120,000. The equipment selection guide has been printed in A5 and laminated for the use out in the community whilst the clinician is with the patient.Staff evaluated the training sessions as highly useful and engaged well with the process. Through the training delivery it was identified that staff in general had a good understanding of the requirements to step up and step down patients between active and static systems.
They welcomed the implementation of a Trust wide process that is clear on equipment selection and reported that the main obstacle to the ‘step down’ process is in fact the resistance from patients and family members and a perception that something is being taken away from patients care. Training provided staff with the confidence to ‘prescribe’ a static surface and built on their understanding of the contraindications of dynamic surfaces and ability to explain why a static surface may meet the patients need better by promoting independence. Awareness raising activities were implemented by Equipment Nurse employed for the CQUIN project – including devising a patient information leaflet.
The selection guide the selection guide assists the clinician to select the appropriate level of equipment for the individual patient and to identify opportunities to ‘step down’ from dynamic support surfaces to high specification foam support surfaces. The Audit process itself and employment of a dedicated Equipment Nurse meant that a number of ‘step down’ opportunities for individual patients were identified, which then reduced expenditure and unnecessary costs by £120,000. Implementation of an Equipment Nurse Specialist role to improve the current local guidance, train district nursing teams and carry out a review of the dynamic mattresses in the community setting to ensure provision of appropriate equipment to meet their needs.
NICE Clinical Guidelines 179 April 2014
CQC Essential Standards (Outcome 11)
Authors: Lucy Welding : Equipment Nurse Specialist : Bridgewater Community Healthcare
Keith Moore : Tissues Viability Nurse : Bridgewater Community Healthcare
Sarah Westcott : Clinical Advisor : Drive DeVilbiss Healthcare