Wednesday, September 26, 2012

“I thought I would die from it”: pressure ulcers: the impact on patients’ lives



At the beginning of September we attended the 10th Australasian Conference on Safety and Quality in Health Care, which was held in Cairns.  The three day conference was a fascinating and informative mix of plenary sessions and abstracts, providing the opportunity to hear messages from national and international experts about what they have achieved in the area of Quality and Safety.
We thought we would share with you one of the sessions which we found particularly powerful and interesting.  It was presented by three staff from Western Health Victoria and demonstrated the enormous impact of digital story-telling in bringing about change to dramatically improve outcomes for patients and clinical staff.

The Western Health team had developed a toolkit which sought to provide a comprehensive communication package for staff to support an organisation-wide campaign to achieve behavioural change in relation to the prevention of hospital acquired pressure ulcers.

Pressure ulcers are one of the top five issues for patient safety.  They are preventable; but failure to properly treat and manage them is likely to result in pain, disfigurement and deconditioning and, in the most serious cases, lead to amputation and even death.

The team used digital storytelling to relate the experience and impact on the quality of life of two patients (and their family and carers) after they sustained grade four hospital acquired pressure ulcers.  Grade four is the most severe category of ulcer and is defined as “full thickness skin loss with extensive destruction and necrosis extending to underlying tissue”.

A DVD formed the centrepiece of the toolkit, which included broader training and presentations.  It also included promotional materials, images of staff taking pressure ulcer prevention measures, evaluation forms and key message items, such as badges and pens.

Participating staff were also asked to complete an open-ended questionnaire, both before and after the educational sessions, with follow-up (including staff opinions of the DVD) at 3 and 12 months. Qualitative and quantitative data was used to measure the impact.

The interim results were very good and demonstrated a real change in staff behaviour.   They described the toolkit as excellent, powerful, moving, confronting and thought-provoking.  A high proportion of staff said they were more vigilant about skin assessment and were focussing on bedside handover and increased sensitivity to patients’ reports of pain.

We watched and listened to the section of the DVD containing the stories told by the two patients; they were moving and distressing in the extreme.  One of the patients said “I thought I would die from it”, because she was in such pain.

The DVD’s greatest value was to trigger behavioural change as a result of the powerful and poignant stories presented.  Involving patients in storytelling in a non- blaming way had enormous impact across the organisation in relation to pressure ulcers and raised multidisciplinary awareness of preventative strategies.

The DVD also led to improved care after discharge from hospital.   Patients discharged after acquiring severe pressure ulcers had an alert placed on their medical records and were issued with an “at risk” card identifying specific strategies required, for example, ensuring appropriate seating is provided - ie comfortable chairs and cushions, when triaged in the Emergency Department.

For us, the key messages from this really worthwhile project and toolkit were: it is vitally important to listen to the patient; storytelling delivers more than just facts - it brings issues to life and aids change; you need commitment and buy-in from all health disciplines to achieve positive change and real improvements for all in health care.

In this case, the moral of the story is “Pressure weights for no-one”.

Kerry Snell and Karen Jameson

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