Friday, 2 August 2013

Nursing care in hospitals

There was a lot of publicity recently around the Keogh Review, which looked into the quality of care and treatment provided by 14 hospital trusts in England with persistently high mortality rates in the last two years. Unusually large death rates do not necessarily mean that the hospitals are poor as there are other factors such as the health profile of a local area that have an impact. Instead, reasons for deaths need to be looked at in detail and the statistics in this act as an alarm sounding that the situation needs to be investigated.
The news headlines were dominated by political punch throwing (not literally!). None of these looked at hospitals that have specialist Spinal Cord Injury Centres, but we looked a bit deeper into the report and were interested in one particular indicator that was analysed in the hospitals; pressure ulcers, more commonly known also as pressure sores.
If you don’t know what one looks like, image search the term pressure ulcer (WARNING! Not for the queasy and faint hearted).
Anyone, including those with full mobility, can get a pressure sore if they stay in one position long enough to place forceful pressure on a particular part of the body. Wheelchair users or those who stay in bed are especially susceptible because they may have difficulty repositioning themselves. It is important that when people are on hospital beds, that nurses are available to move patients regularly. When limited mobility is coupled with impaired sensation, a person is more likely to develop a pressure sore due to the inability to sense when to make a weight shift in order to relieve pressure. People with Spinal Cord Injury have a greater risk of developing one.
It was found that half of the hospital trusts had performance levels outside of the expected range for pressure ulcer care. Another report following a survey from the Florence Nightingale School of Nursing and Midwifery in London found that nurses at NHS hospitals were being overstretched and that they were actually rationing the care that they were providing to patients due to time pressures.  The Keogh report was particularly scathing on the standards of nursing care and staffing levels at these hospitals.
We’ve heard some real horror stories from people with spinal cord injuries who have been to general hospitals. People tell us all the time that the nurses don’t understand how important it is to make sure that spinal cord injured patients change their position regularly. Aspire advises that when people to go to non-specialist Spinal Cord Injury Centres for treatment, that they contact their centre and also ask the hospital they are going to contact their Spinal Cord Injury Centre too. It is important that hospitals receive the specialist guidance they need to ensure that not only pressure sores are prevented, but also bowel and bladder complications do not arise.
Keogh recommended that more work was needed to reduce incidents of pressure ulcers and that there was “poor quality root cause analysis of incidents and limited dissemination of learning from when things go wrong.”
We find this concerning. We would like things not to go wrong in the first place, but when it does, the least we can expect is for it to be investigated so that lessons can be learned from it. The fact that it wasn’t shows people were being failed and arrangements for patient care were not scrutinised.
They can lead to people spending months on bed rest. What’s more, they are preventable and if developed, can also be managed so that they don’t become more severe.
We have spoken with many people who have experienced pressure ulcers at general hospitals. It is not unusual for people to arrive at spinal cord injury centres with pressure ulcers. In terms of patient rehabilitation, this causes further delay and slows down progress.
Having the right mattress and making sure that patients are regularly turned are just two ways in which these pressure ulcers can be prevented.
In our experience, we believe that there needs to be more awareness among staff at general hospitals about pressure ulcers. There needs to be an urgent review into the levels of staffing on wards. Pressure ulcers are easily preventable, but it does require a certain number of staff to be able to ensure this is possible. Cuts in staffing levels not only increase the likelihood of people experiencing pressure ulcers, but the additional time and care required to then manage and heal them will cost the NHS more in the long term. Investing time and money in prevention is in the interest of both patients and the NHS.
- Aspire Campaigns and Research Team

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