Out of the box thinking in pressure injury prevention

More than 60 000 patients in Australia’s hospitals and care facilities suffer from one or more pressure injuries, also known as pressure ulcers or bedsores, at any given time. It costs well over $60 000 to treat a pressure injury and litigation costs can run into six figure sums. Kate Sharp*, CEO at The Wound Centre took the time to speak to us about issues in assessing the risk for pressure injuries and the need for immediate attention and treatment.

IIR Healthcare: In your recently published book Pressure Sores: The ‘Nurse you’re killing me’ series you are presenting a unique model of care developed to completely prevent pressure injuries. How did you develop this approach and how does it differ from more conventional methods?

Kate Sharp: Australian nurses and care professionals currently have to follow  Clinical Guidelines for the Prevention and Management of Pressure Injuries. I believe that not all the information provided in these documents is correct and will not lead to a reduction of pressure injuries.

Just to name one example, nurses are currently not required to assess the risks for pressure injuries for hours after the patient has been admitted to the healthcare facility. Yet, if the patient cannot move they are at risk of pressure injury. An ischaemic event can begin after five minutes of unrelieved pressure on any part of the body that is sandwiched between the mattress and the bony skeleton. The patient needs immediate pressure relief and this can be easily achieved by moving them on an alternating pressure air mattress.

Using my method, it takes 30 seconds or less to assess if a patient is at risk. You just need to ask a couple of very simple questions. To find out what they are you’ll need to read my books Pressure Sores: The ‘Nurse you’re killing me’ series and Sharp Clinical Solutions for the Prevention of Pressure Injuries.

I know I am very outside the box of what is currently common and recommended practice in the wound care sector, but I would rather see myself as a good patient advocate. Pressure injuries are a very serious problem that can lead to sepsis, amputation of lower limbs and even death.  From my experience I know that we have to keep things simple to make them successful in the realities of day-to-day nursing care practices. Nurses are far too busy to be completing time-consuming risk assessment tools, which are simply not necessary. Fast risk assessment can save a lot of time, money and work. Yet, the information that is put out around pressure injury prevention is often hundreds of pages. Nobody has time to read all that.

IIR Healthcare: Why do you think you are facing resistance when it comes to adopting a simpler risk assessment model?

Kate Sharp: That’s a difficult question to answer. I think a lot of it may have to do with the fact that nurses don’t really have the authority and their experience and expertise is unfortunately not considered in management and purchasing decisions. Wound care has always been the domain of nursing staff, but I think that medical staff needs to get involved in order to make a difference. If a surgeon demands that a patient is put on an alternating pressure air mattress after an operation, it will happen. And after all the healing process of the surgical wound is a crucial part of a successful procedure. The patient should be able to recover and go home without developing pressure injuries which are severe and avoidable adverse events.

IIR Healthcare: Do funding issues inhibit hospitals and care facilities to purchase enough alternating pressure air mattresses to respond to risks adequately?

Kate Sharp: Not if you consider that the costs of treating an ulcer run well over $60 000 and that there are more than 60 000 patients in Australia who suffer from a pressure injury at any time.  A good alternating pressure air mattress costs a few thousand dollars and will save a facility a lot of money in the long run.

IIR Healthcare: In your opinion, what is the main factor inhibiting better pressure injury prevention in the Australian healthcare system?

Delaying the assessment of a patient! Just like a heart attack, the development of pressure injuries is an ischaemic issue. When a patient reports chest pain, the treatment must start immediately in order to prevent the lack of blood supply causing serious and life threatening damage.  I want to see the same urgency applied to the risk assessment for pressure injuries. If the information in current guidelines were evidence-based, we would not have so many patients in our healthcare facilities who are suffering from pressure injuries.

IIR Healthcare: Can you tell us a bit more about yourself and what led you to set up the Wound Centre?

Kate Sharp: I first got into wound care when I came back into the workforce after a period of illness in 1989.  I had been working in an emergency department, but had to take on light duties.

Back then the common practice and products that were used for wound care were very different from how we work now. Dressings were often changed every four hours and patients were constantly required to come back to the emergency department to have them changed. It was a painful process for the patient and time-consuming for the nursing staff. At the time, the hospital I worked for got requests from healthcare supply company representatives to trial new products such as DuoDerm, a hydrocolloid dressing and Sorbsan, the first alginate dressing I came across. I was tasked with trialling these products in the clinical setting and the experience was a revelation for me. All of a sudden, we had products that only needed changing every one to seven days. It was an incredible advantage since it actually allowed the wound bed enough undisturbed time to heal.

The suppliers also played an important part in bringing together nurses from across NSW. That’s how I became involved in the Steering Committee for the Wound Care Association of NSW. And the membership of the association just kept growing! After a while I noticed that there was no central point of information for nurses to get reliable information about products and practices, so I set up the website with the help of my son. We now have thousands of members in over 30 countries.

IIR Healthcare: You will be presenting at the 2^nd annual Reducing Avoidable Pressure Injuries conference. What discussions are you most looking forward to?

I really enjoy going to these events and am looking forward to hearing what everyone has to say. I love the networking and can’t wait for some heated discussions.

*Kate Sharp has practised as a pressure injury prevention/wound management/infection control consultant for the past 21 years in several hospitals  and approximately 350 residential aged care facilities in and around Sydney and the community.

As well as being a published author, with five books on Amazon, Kate has a Master of Clinical Nursing, a Master of Public Health and a Master of Health Law. She is currently working on her PhD in pressure injuries in residents with dementia.

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