We need to protect people suffering from pressure injuries

In 2015 a KPMG report outlining the case for investment in a quality improvement programme to reduce pressure injuries (PI), found that 55,000 people suffer from a PI in New Zealand every year. Alarmingly, the report also found that over 3,000 people each year go on to develop severe (Grade III or IV) PI, resulting in a significant negative impact on their quality of lives.[i]

Given that PI are largely avoidable and progressive [meaning they deteriorate through each category of severity (category I, II, III & IV)]; the KPMG report states that PI above grade III should be considered “never” events – events that should not happen. Sadly grade III and above pressure injuries have the biggest financial cost to the country and greatest personal or “human’ cost to an individual and their families. The average cost of treating a stage III PI is $123,000 per person and includes costs like rehabilitation, human resource, clinical supplies, additional length of stay in hospital and the further complications. What this figure can’t account for is the human cost of which according to the KPMG report, may include “Constant pain, loss of function and mobility, depression, distress and anxiety, embarrassment and social isolation, increased financial burdens, prolonged hospital stays, septicemia, and even death.”

Are PI reducing in Aged Care?

Among at risk groups for PI are elderly New Zealanders. Late last year the Ministry of Health reported they were “encouraged” by the findings of an audit into Pressure Injuries in Aged Residential Care, which found that 96% of the facilities audited had policies and guidelines in place to reduce PI’s.[ii]

Although it’s encouraging to see many facilities have established policies and guidelines, the Ministry of Health audit made some findings that were not highlighted by their media report such as:

• Of the 528 providers audited, 299 had residents with PI
• 196 injuries were grade III and above (considered “never” events by the KPMG report)
• The majority of PI occurred at hospital level care
• The majority of residents with PI obtained them at their Aged Care facility (610 people).
• Four Aged Care facilities provided incorrect equipment or no equipment for pressure relief for clients with existing PI

What can we learn from this?

While there is still some work to be done to help prevent PI in the Aged Care sector, preventing PI is not overly complicated. With robust policies, guidelines, action plans, regular internal auditing, staff training and knowledge, we believe most (if not all PIs) could be prevented.

Simple tools like using the SSKIN approach to manage and prevent pressure damage are extremely effective

• Surface – supportive and pressure relieving surface 
• Skin inspection – at regular intervals to find any potential areas of damage
• Keep Moving – encouraging clients to change position regularly
• Incontinence – keeping clients clean and dry to protect their skin
• Nutrition – healthy eating with plenty of fluids to nourish the skin

Should NZ invest in a national quality improvement programme?

A National sponsored quality improvement programme in the Netherlands resulted in a 75% reduction in PI in Aged Care Facilities and 65% reduction in hospitals over a 12 year period.*

Image source: Source: Halfens, R.J.G.. Meijers, J.M.M., Meesterberends, E., Neyens, J.C.L.. Rondas, A.A.L.M., Rijcken. S., Wolters S., Schols, J.M.G., ALandelijke prevalentiemeting Zorgproblemen Rapportage resultaten. Universiteit Maastricht, CAPHRI, Department of Health Services Research. The Netherlands, 2014.

How did they achieve these results?

• They kept solutions simple
• Right equipment at the right time – ensured essential equipment was accessible to staff
• National improvement in clinical practice – improved staff knowledge and training
• Engagement and empowerment of families/Whanau through education systems – improved information available to an individual’s support network
• Greater collaboration and communication between health providers – good handover from hospital back to care facility and vice versa
• Cultural and behaviour change nationally to prevent PI
• Investment in ongoing education, training and equipment to prevent PI which resulted in cost savings over time

While ACC, the MoH and the Health Quality and Safety Commission are currently working together on a number of measures including the development of a national approach to the measurement and reporting of pressure injuries, greater emphasis should perhaps be placed on preventative programmes, early detection and treatment is key to avoiding and minimising the impact of PI.

Whether we follow the Netherland’s lead and establish a national quality improvement programme remains to be seen. What we do know, is that if we are going to reduce PI in the Aged Care sector and ensure elderly New Zealanders don’t continue to suffer unnecessarily, then we need further investment in national education and training programmes. We also need to ensure quality pressure care equipment is available to all those who need it.

While there is little doubt we are getting better, we can all be better.

Claire Bingham is an Occupational Therapist at Cubro who has a passion for helping prevent pressure injuries, especially in high risk individuals. With 13 years of experience as an Occupational Therapist and 7 years specialising in Spinal Cord Injuries for the Auckland Spinal Rehab Unit. Previous experience in Hospice, Community, Assessment, Treatment and Rehabilitation (AT&R), Medical, Surgical and Orthopaedics.  

 As part of our in-house OT team, Claire uses her experience to help customers find equipment solutions that will help their clients to achieve the best possible health outcomes.