Interview: Interview Elaine Bethell

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An interview with

Elaine Bethell inadequate resources and lack of admin support.Difficulties also arise if patients are in another trust—some areas don’t have or only have limited tissue viability services. Another issue is time—staff are really willing and keen to learn, but releasing them for education and training can be a major challenge, which becomes a ‘catch 22’ situation. Patients surviving longer is also a challenge. There’s now more survival with comorbidities, people with complex wounds and frail skin. Building a team is tough. Coping with the demand and the ever-changing business planning process that often accompanies this increase is tough. Nurses are usually not well trained in the business planning process, even though it is necessary. Gaps in skills and knowledge in all health-care settings is variable. Organisations may cut training budgets, and private entities and care and nursing homes are expected to provide their own. Therefore, this may not be a priority where money is tight.

Elaine Bethell email: [email protected] Lead Nurse, Tissue Viability, Worcestershire Acute Hospitals NHS Trust

© 2014 MA Healthcare Ltd

What made you go into tissue viability? As a nurse/ward manager I always had a passion for preventing pressure ulcers. In 1993, in light of the Touché Ross report highlighting costs of pressure ulcer prevention and treatments, the Trust where I was working wanted to assess the extent of the pressure ulcer problem and develop a strategy to reduce harms to patients and costs to the Trust. I was appointed within the project team for a secondment to ascertain and baseline the number of pressure ulcers within the Trust and scope what equipment we had and what was needed. I quickly developed a real passion for working in wound care—making a difference and preventing pressure ulcers. I then became involved in assessing wounds other than pressure ulcers (much to my boss’s annoyance!).

What challenges have you faced as a wound care specialist? Increased demand for assessments, advice and support with

What are the biggest concerns for patients with chronic wounds and how can wound care professionals rise to the challenge? Different local health-care commissioners and providers may not consider wound care as top of their agenda. Therefore, equitable care sadly is not always available. Knowing how to access, and actually accessing, appropriate care can be a challenge for patients and staff. Dressing changes must be done in a timely way to suit their lifestyle and individual needs. Many patients worry about taking time off work, holidays etc. For patient exudate, smell and the inconvenience of having to travel for dressing changes or waiting in for a district nurse can be very frustrating—especially if you need to be at work. Furthermore, not all employers are sympathetic to patients’ individual needs. As wound care professionals we can rise to the challenge by uniting and being one voice, raising awareness within the Government that there are other patient wounds other than pressure ulcers which can lead to serious harms and need addressing with as much vigour. We must develop and support flexible standardised pathways and guidelines that allow for individual patient needs, and consider telehealth within the patient’s home setting. We can recognise that tissue viability/ wound care clinic/other services may need to cater for a 6 or 7-day working week and be available in the evenings—not the

Community Wound Care September 2014 Journal of Community Nursing. Downloaded from by on November 19, 2015. For personal use only. No other uses without permission. . All rights re

Interview: Elaine Bethell

traditional 9 to 5pm. The NHS is moving towards a 24/7 service and tissue viability must move with the times to accommodate individual patient and NHS needs.

How can health professionals ensure that national and local guidelines are implemented in clinical practice? This is difficult to answer—but implementation of the ‘worldwide’ pressure ulcer prevention and management guidelines due to be launched at the European Pressure Ulcer Advisory Panel in August 2014 will be a good indicator of how, as health-care professionals, we can work together and implement such well-researched and clinically valid guidelines Other guidelines related to wound care need to be agreed (not imposed), be flexible for individual patients and local variances. Education and training is paramount—we should involve our partners in industry. Many have experienced wound care, and tissue viability nurses working with them are willing to help. We all need to work together, and all regional groups, national and international groups and conferences need to reflect the progress supported by best practice statements. These statements need to be endorsed at Government level for all health-care professionals to utilise within their practice, irrespective of location.

In what ways are you working to improve patient care? The main focus for the Trust at present is to reduce the number of avoidable pressure ulcers and patient harms. Avoidable pressure ulcers are recognised as a devastating experience for patients, their families and carers, and are seen as key indicators of the quality of nursing care. In NHS Midlands and East, ambition 1 was to achieve zero avoidable pressure ulcers by December 2012. This was clearly articulated as a critical priority and also became an urgent priority objective for Worcestershire Hospitals Acute Trust for 2012/13. Gaps in documentation, delays in heel protection, and irregular moving of patients are the prime causes of grade 2 and 3 pressure ulcers. A Rapid Spread Solutions model was implemented. This uses a process of winning hearts and minds and convincing that this is the right thing to do. Mobilising staff to achieve a common goal, implementing large-scale change and removing barriers to change at a very fast systematic pace are all imperative. All health-care professionals have their roles and individual accountability. The difference with this model is that it becomes a new way of life as opposed to a ‘project’ initiative. This results in firmly embedded, sustainable processes and change. The SSKIN bundle has been incorporated within the intentional rounding: care and comfort rounds, improved user-friendly documentation, patient information, different ways of working, and time frames regarding baseline skin assessment and equipment provision have been enhanced.

A robust process of reporting and monitoring has been developed, and any patient that now develops a grade 2,3 or 4 pressure ulcer must have a root-cause analysis completed. Weekly pressure ulcer prevention sustainability audits take place and areas that don’t achieve the standards set are monitored, with action plans put in place. This successful approach has enabled significant reduction in avoidable pressure ulcers. No grade 4 pressure ulcers have been reported since November 2012, some months no grade 3s have been reported and the numbers of grade 2 ulcers has significantly reduced.

What are your views on ‘no avoidable pressure ulcers’? We should continue to strive for zero pressure ulcers and no harms to our patients. However, we have a robust process of scrutiny and accountability meetings that do demonstrate that 30–50% of pressure ulcers that develop are actually unavoidable for various reasons. Work on this subject has recently been published and is demonstrating similar outcomes to ours. If all care is clearly planned, documented and carried out in an individual, timely manner and is flexible to meet changes in a patient’s condition, then pressure ulcers may be deemed unavoidable.However, we are not complacent and recognise that we still need to look at these areas of concern and challenges to reduce them.

What do you enjoy about your role? I have a passion for wound care and pressure ulcer prevention. Supporting and advising patients and staff to help heal a complex wound is extremely satisfying. I am lucky to really enjoy working with the staff in my own team, Trust, surrounding Trusts, peers, colleagues and partnerships with universities and companies.Making a difference to patients and their lives and going the extra mile to help support them is fantastic—facilitating a complex discharge to enable patients to return to their own home environment. Education and training and supporting and developing staff and the team, being involved in new products and developments, and the ability within my organisation to lead systematic improvements in patient care all drive me. Rewarding success and having fun when appropriate is important too!

What advice would you give to budding woud care professionals? Don’t give up! If your passion is tissue viability and wound care, make yourself known to your tissue viability team, write a case study, ask for help, educate, or become the tissue viability link nurse/champion. Be prepared to work hard and face many challenges—but stay strong, clear and focused.

© 2014 MA Healthcare Ltd

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Community Wound Care September 2014 Journal of Community Nursing. Downloaded from by on November 19, 2015. For personal use only. No other uses without permission. . All rights re

An interview with Elaine Bethell.

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