Pressure ulcer prevention - Healthcare professional testimonial
As a tissue viability nurse, Alison Johnstone has thirty years of experience in the management of patients with acute and chronic wounds, as well as prevention and management of pressure damage. She is a recognised member of the Wound Care Round Table run by Wounds UK and shares her expertise through specialised tissue viability and wound care training sessions. Alison is committed to treatment innovation, she has authored product reviews for newly approved wound care products and has co-investigated a trial of wound dressings containing silver, published in the International Wound Journal.
Throughout her extensive, first-hand clinical experience, Alison is constantly reminded of the burden pressure ulcers put on patient care services. Her current facility, the NHS Greater Glasgow and Clyde, admits up to 300 patients per month, of which up to 50% may be suffering from pressure ulcers on admission. A further 10% go on to develop pressure ulcers during their stay and in the geriatric department this percentage is markedly higher.
Over her tenure, Alison has observed that multiple factors contribute to the formation of pressure ulcers, including friction, incontinence and of course pressure, but rarely pressure alone. The close patient contact, which is fundamental to the role of a tissue viability nurse, exposes Alison to the physical and psychological pain associated with these ulcers. This psychological pain can’t be measured - she says that sufferers’ pain often stems from them feeling dirty, they become isolated and they don’t like losing their independence or mobility. They feel a burden and lose control of looking after their own lives.
Ulcers require constant care and when they become infected can exclude the patient from scheduled surgery, resulting in longer hospital stays and blocking beds of others awaiting surgery, thereby increasing waiting lists and increasing costs.
Wound management is an integral part of patient recovery and no matter how well managed, pressure ulcers can result in significant scarring which can be disfiguring and can impose an increased risk of skin abrasion and deterioration. Thirty years ago, nurses performed regular patient rounds specifically to monitor the skin’s condition. Now, Alison remains an advocate of continuous patient assessment and multiple prevention tools, particularly as she observes that hospitals are spending millions to treat pressure ulcers. To this end Alison has recently completed an evaluation of a specific dressing (Mepilex Border Sacrum from Molnlycke Health Care) for the sacral area to augment her pressure ulcer prevention protocols for high risk patients. This dressing has been shown to help minimise pressure ulcers1 and Alison’s evaluation has validated this in the NHS Greater Glasgow and Clyde ICU unit.
Alison understands that pressure ulcers will never be completely eradicated, but urges hospitals to reallocate resources to enable risk assessment and to implement multiple preventative measures. There is no question that prevention should be a priority; Alison’s experience shows that treatment is much more costly and causes an immeasurable amount of patient pain. The future vision for NHS Greater Glasgow and Clyde would be to achieve zero tolerance for preventable pressure ulcers .
Alison Johnstone, Clinical Nurse Specialist (Tissue Viability), NHS Greater Glasgow and Clyde.