The role and impact of honorary contract staff within an NHS Trust
Historically the honorary contract model has been used for clinical academic doctors employed by higher educational institutions (1) however there are a number of nurses who are now employed in the role of honorary contract Tissue Viability Nurse within the NHS.
The NMC (2) states the need to prioritize people, practice effectively and preserve safety and promote professionalism and trust. Along with these the adherence to the principles of confidentiality, research awareness and ethical awareness are paramount for the honorary contract nurses.
Both honorary contract nurses work two days a month on defined projects with agreed objectives, as confirmed during their annual Key Performance Indicator meetings .The projects follow a research structure with specific criteria in order to deliver upon the required outcomes and cover: Education, Research, Clinical and leadership.
Recent projects undertaken:
- Following a review of the Skin assessment guideline, a need for focused awareness was identified for patients with fragile skin who were having medical adhesives removed from their skin. This included an evaluation of SMARS in clinical practice, which led to the development of the Skin Integrity Model (SIM), these were supported by 2 clinical focus groups and consensus gained from 400 nurses.
- Pressure ulcer education identified a skills gap in the differential diagnosis of moisture lesions and pressure ulcers; this led to the development of the Moisture or Pressure Tool (MOPT). 255 nurses’ opinions were surveyed on their opinions, resulting in the tool refinements as once implemented, this would assist with the clinical decision making of 2000 clinical staff in a large NHS Trust.
Both projects supported the informal and formal assessment undertaken by clinicians in relation to skin assessment. This forms part of the individuals overall professional development within the Knowledge and Skills Framework (3).
The development of the SIM has enhanced the existing skin assessment guideline (4), updated the skin assessment tool and delivered education to raise awareness of the importance of detailed nursing assessment for those patients with fragile skin during the removal of medical devices and dressings through the appropriate use of SMARS.
The development of MOPT and its education platform have provided a visual tool enabling staff to differentiate between moisture lesions and pressure ulcers more effectively.
A recent feedback survey revealed that
95% (n= 243) said that the MOPT was easy to use
95 %( n=243) said it assisted with differentiation
100% (n=255) said the education supported their clinical practice
100 %( n=255) said the tool and education supported the development of appropriate care strategies
100 %( n=255) said the tool raised the profile of appropriate continence and tissue viability care
The SIM has enabled nurses to identify at risk patients of potential skin trauma following the removal of medical adhesives through the introduction of an amended skin assessment tool and supporting the appropriate use of Silicone Medical Adhesive Removers.
This has been presented during its development and published in Wound Essentials in 2015 (5) and presented e. Posters to the European Wound Management Association Conference 2015 (6) and 2016 (7) this survey assessed the prevalence of fragile skin of patients across four nursing area within the Trust; District Nurses, Tissue Viability Link Nurses, care homes and a community hospital.
Following the introduction of the MOPT, the trust pressure ulcer reporting system has identified that no moisture lesions have been reported in the last year. This is a significant improvement on the previous year when over 100 were misdiagnosed and reported inappropriately, thus taking valuable time in management and administration. Additionally, care homes are also no longer reporting moisture lesions inappropriately. The Trust has achieved the CQIN target by reducing the number of avoidable pressure ulcers by 26.1%
The Tool has been presented throughout its developmental stages at the EWMA conference in 2014(8), 2015(9) and 2016 (10). As a result the following countries have now implemented the tool England Wales Israel, Sweden, Portugal, Germany and Spain. It has also been published in the EWMA journal in 2015(11).
The assessment and management of skin has become a significant issue within clinical practice which has been supported by two of our honorary contract staff. The SIM has supported appropriate care delivery whilst the MOPT supports accurate pressure ulcer data collection which has prevented inappropriate referral and delay in treatment plan and care provision. A MOPT paediatric version is currently under review to support the differentiation of pressure ulcers from other common causes of skin damage.
References (not included in word count)
(8) EWMA ( 2014) oral presentation:
(9) EWMA (2015) Oral presentation: The outcomes of 100 patient survey to EWMA 2016
(10) EWMA (2016) Oral presentation:
(11) Stephen-Haynes,J. Callaghan,R. Evans,M & Simm,S. (2015)Development and Implementation of a Tool to Assess and Differentiate Moisture Lesions and Pressure Ulcers. EWMA. Vol 15 No 2, p37-38 http://ewma.org/fileadmin/user_upload/EWMA/pdf/journals/Scientific_articles/Articles_October_2015/6._Development_and_Implementation_of_a_Tool_to_Assess_and_Differentiate_Moisture_Lesions_and_Pressure_Ulcers.pdf