Pressure Injuries (PI’s) are a major burden to both patients and healthcare providers. NHS England (NHSi, 2014) state 700,000 people are affected by PI’s each year costing the NHS £3.8 million per day. Current research and policy position PI’s as an acute hospital based problem (Jackson et al., 2016), however the majority of patients are living with chronic PI wounds, receiving treatment within the community (Bennett at al., 2004; Stevenson et al., 2013). Information regarding the extent of PI’s in community based adults is lacking and urgently needs addressing as healthcare undergoes a national shift from hospital to home based care provision (NHS 5YFV, 2014). New research is required to not only evaluate the extent of service provision required for community based PI patients but more importantly to understand the care needs and preferences of patients to provide a safe and patient focused service.
Methods:
As part of an ethically approved university funded project, all mandatory incident reports of PI’s from 2015 were collated from a case study region defined by a single postcode district. Information from reports and district nursing notes were cross-reference to produce detailed demographic and pressure related information. Descriptive statistics (SPSS v22.0 IBM) were used to describe patients within the case study region. To illustrate the burden on service provision, records of PI related equipment given to community dwelling patients were analysed. Semi-structured qualitative patient interviews were conducted with appropriate consent to build a perspective of the burden of living with a PI by individuals within their own homes, and to gain an insight into their understanding and use of pressure relieving equipment.
Results:
50322 adults lived in the case study region, 3086 were aged 75+ (ONS, 2011). In 2015, 103 individuals received community based care for 137 PI’s. Multiple combinations of equipment from several manufacturers were supplied, but further analysis showed patients concerns about its use and more patients were likely to not use the equipment as per manufacturer’s instructions, than to use it correctly. Narratives of patients revealed the greatest personal burden of living with a PI was living a life of pain, describing days that were clouded in pain; a pain they felt was poorly understood and managed and often out of control. Continuity of care, and the trust built from stable relationships, and knowing their care providers, was fundamental to their personal wellbeing and potential for recovery.
Conclusion:
Using a case study approach we have demonstrated that home dwelling patients represent the complete spectrum of PI’s including those with full skin thickness damage (Cats 3 & 4). Equipment to relieve or prevent pressure damage is provided extensively into patients homes, even despite a lack of robust evidence that the equipment is beneficial (McInnes et al., 2012). The multiple combinations and choices of specialised equipment supplied perhaps suggest that the system is tailored to meet individual patient needs. However, this study has found that appraisal and re-appraisal of equipment once in a patient’s home is lacking and equipment is often redundant or used incorrectly. Furthermore, participant narratives indicated their pain was poorly recognised and under-treated. People living with PI often struggled to maintain continuity of their own care and should have opportunities for dialogue and mutual decision making with health professionals. Further work focusing on the perspectives, understanding and choices of home dwelling patients is imperative because of rapid growth in this sector of the community.
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