Outcome 7. Safe and effective care - pressure area care/continence care
Where avoidable, people with dementia do not acquire a pressure ulcer during their stay in hospital. If they are admitted with a pressure ulcer, their care is tailored to their needs - ensuring the care is delivered in line with the NHS Quality Improvement Scotland Best Practice Statement for the Prevention and Management of Pressure Ulcers, so those at risk of a pressure ulcer are identified and receive care to minimise the risk, including access to a local wound care formulary. People with dementia have their continence care needs assessed, planned, implemented and evaluated in a person-centred way.
A range of scales and assessment tools is in use across boards, including the Waterlow tool, Braden scale, Pressure Ulcer Risk Assessment (PURA) tool, NHS Quality Improvement Scotland Best Practice Statement on Prevention and Management of Pressure Ulcers, the Clinical Quality Indicators and the SSKIN bundle.
The National Association for Tissue Viability Nurses in Scotland assessment chart for wound management is used in the hospital in NHS Western Isles and includes documentation for performing formal wound assessments, planning treatment and evaluating effects. Boards are also using their own pressure area care guidance and wound care formularies: they generally have access to specialist tissue viability services and have high-level strategic steering groups (or equivalent) in place. Therapeutic equipment (including pressure-reducing mattresses and cushions) is commonly available and nurse advisers are usually on hand to provide training and education for staff.
NHS Greater Glasgow & Clyde commissioned prevalence studies over three years to capture pressure ulcer incidence in a defined 24-hour period. Mental health services had an incidence of less than 4% in the first two studies, and it was acknowledged that the future focus should be on prevention, management and further reduction in ulcers developed by patients while in the board's care.
Boards and their contracted care providers aim to provide appropriate assessment, individual management and care for all patients living with dementia with continence needs. The objectives of the continence assessment process in NHS Lanarkshire, for instance, are to establish the cause and contributing factors, initiate an agreed personal care plan, enable the person to achieve and maintain the optimum level of continence and quality of life, and review continence status regularly. Where appropriate, referrals are made to the specialist continence service. All care environments have been assessed and adapted to dementia specifications, which includes easily identifiable toilets with clear signage and features within each toilet to help patients to be as independent as possible.
Email: Ian Roxburgh
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