Journal of Community Nursing

52 JCN 2020,Vol 34, No 4 WOUND CARE P revention, treatment, and management of pressure ulcers (PUs) is a key indicator of quality, safety, and patient care experience. In the UK, the National Health Service Safety Thermometer (NHS-ST) reports 8.4 million PU- related data points added 2011– 2018 (NHS Improvement, 2018). However, deep-dive analysis of the NHS-ST data suggests that the largest numbers of new cases of PUs developed in nursing homes and/or community settings, contributing to national PU incidence and prevalence. Implementing a new approach to pressure ulcer prevention Nicky Ore, Tracey Carver The cost burden of PU treatment is high. Guest et al (2018) estimated mean NHS cost of PU care over 12 months at £8,700 per PU (£1,400 category 1; £8,500 categories 2–4). While district nurse visits driven by PU treatment accounted for ≥ 80% of the cost burden, approximately 98% of this cost was associated with PU care in community settings (Guest et al, 2018). A cost comparative case study illustrated the significant cost implications of treatment versus prevention. While prevention is not free, the study demonstrated that costs of treatment far exceed those of prevention, suggesting that more Nicky Ore, head of clinical governance; Tracey Carver, quality lead nurse, both at Mersey Care NHS Foundation Trust With pressure ulcers remaining a challenge to the healthcare system across all care settings, this 12-week pilot study aimed to evaluate implementation of the SEM Scanner as an adjunct to standard of care (SoC) in pressure ulcer (PU) prevention. Two district nursing bases enrolled 17 palliative care patients, who received SoC and preventive interventions. Patients with Waterlow scores 10–19 who were able to be scanned for three consecutive days were included. Broken skin was not scanned, and visual skin checks were documented after SEM scans. Patients with SEM delta ≥0.6 were considered at high risk and preventive interventions were escalated using a clinical decision matrix aligning with SoC. The study found that implementing the SEM Scanner in an existing PU prevention pathway resulted in a reduction in community-acquired PU (CAPU) incidence by 26.7% from 16.1% to 11.8%; 88% (n=15) of patients remained PU free. Furthermore, clinical judgement informed by SEM deltas resulted in 82% (n=14/17) of nurses reporting that the SEM delta had changed their clinical decision-making. KEYWORDS:  SEM Scanner  Delta readings  Pressure ulcer  Incidence reduction  Standard of care  Clinical decision matrix effort needs to be made to address the latter (Gefen et al, 2020). The patient care experience, including pain, loss of function and mobility, depression, and social isolation (Charalambous et al, 2018) are far less reported, thereby confounding the true cost of treatment. Preventing PUs improves care, which impacts the overall wellbeing of patients (Moore and Patton, 2019). The cost burden in community care settings has encouraged NHS trusts to develop multiple initiatives to achieve PU incidence reduction (Guest et al, 2018). However, despite awareness campaigns, such as React to Red, education, increased use of risk assessment tools (RATs), improved protocols and guidelines and utilising the SSKIN bundle to improve care, PUs remain a significant healthcare problem. A review investigating the use of PU risk assessment tools found‘low’ or ‘very low’certainty of evidence that such tools reduce the incidence or severity of pressure injury (PI)/PU (Moore and Patton, 2019). To align with NHS objectives in reducing PU incidence, Mersey Care NHS Foundation Trust (MCFT), a community care provider, implemented a pilot study as part of their PU reduction strategy. The aim was that the objective data collected would inform targeted clinical interventions to improve their PU prevention practices. MERSEY CARE NHS FOUNDATION TRUST (MCFT) MCFT serves a population of over 11 million in North West England, providing high secure adult specialist mental health, addiction, learning ‘The cost burden in community care settings has encouraged NHS trusts to develop multiple initiatives to achieve pressure ulcer incidence reduction.’