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A billion dollar question about the prevention and management of pressure injuries

In a recent article at Croakey, the CEO of Wounds Australia, Anne Buck, raised concerns that the new edition of the National Safety and Quality Health Services Standards may weaken efforts to prevent and improve management of pressure injuries.

In response, Dr Robert Herkes, Clinical Director of the Australian Commission on Safety and Quality in Health Care, explains below why the Commission believes the new standards strengthen the focus on pressure injury.

This is a significant issue, both for patients and health care systems, with estimates that 15-25 percent of patients in the health system develop pressure ulcers.

Pressure injury is considered one of the most common causes of iatrogenic harm to patients, with the total economic burden to Australia estimated at $1.8 billion per annum, including treatment and other costs.


Robert Herkes writes:

The National Safety and Quality Health Service (NSQHS) Standards were developed by the Australian Commission on Safety and Quality in Health Care in collaboration with the Australian Government, states and territories, clinical experts, patients and carers.

RobertHerkes
Dr Robert Herkes

The primary aims of the NSQHS Standards are to protect the public from harm and to improve the quality of health service provision. They ensure that relevant safety and quality systems are in place to ensure expected standards are met.

The second edition of the NSQHS Standards, released in November 2017, has received strong support and positive feedback.

The Commission conducted extensive public consultation and piloting on the content and structure of the second edition of the NSQHS Standards. Individuals and organisations with an interest in pressure or wound management contributed to this process.

The approach taken in the second edition is to place the patient at the centre of care.

Comprehensive care

Pressure injuries remain an important component of the second edition of the NSQHS Standards and actions to ensure they are treated appropriately are incorporated into the new Comprehensive Care Standard.

The purpose of the Comprehensive Care Standard is to address the cross-cutting issues underlying many adverse events.

Health service organisations will still be required to implement strategies to prevent and manage pressure injuries as required by the first edition.

While the number of individual actions has been reduced, this has been achieved by combining separate actions, or by streamlining them to eliminate duplication.

It does not mean there is less focus on pressure injuries in the second edition of the NSQHS Standards, or that hospitals and health organisations are expected to do less to address this issue.

Actions in relation to pressure injury required in the second edition of the NSQHS Standards include:

  • Implementing systems for prevention and management of pressure injuries in line with best-practice guidelines
  • Conducting comprehensive skin inspections in accordance with best-practice time frames and frequency
  • Providing education to patients, carers and families about pressure injury prevention and access to equipment.

The only difference associated with changes in the second edition of the NSQHS Standards is that health service organisations will now need to consider all relevant risk factors that a patient may have that may contribute to their pressure injury risk, such as their level of cognitive impairment, nutrition and hydration, and falls risk.

Stronger focus

The Commission does not agree that the reduced number of actions relating to pressure injuries will dilute efforts to minimise patients’ risk of harm. In fact, the Commission believes the focus on pressure injury has been strengthened.

To ensure that action on pressure injuries is maintained, the Commission has used the pressure injury icon from the first edition throughout its implementation resources.

The pressure injury icon is well recognised throughout the sector and is used to highlight actions in the second edition of the NSQHS Standards related to pressure injuries. The Commission believes this will help to ensure that the requirements for pressure injury remain prominent.

Health service organisations will begin assessment to the second edition of the NSQHS Standards from 1 January 2019. To maintain their accreditation status health service organisations must demonstrate that they have met all actions in the second edition of the NSQHS Standards, including actions related to pressure injuries. A comprehensive training package for assessors on the second edition of the NSQHS Standards is also being developed.

The Commission firmly believes the second edition of the NSQHS Standards strengthens the focus on pressure injuries, rather than weakens it.

While the new standards are expected to be in place for at least a decade, the supporting resources produced by the Commission to assist health services implement them will be updated as required on a more regular basis.

The Commission has invited Wounds Australia to work collaboratively to address any gaps that may be identified in the resources supporting the second edition of the NSQHS Standards.

• Dr Robert Herkes is Clinical Director of the Australian Commission on Safety and Quality in Health Care.

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