1
TISSUE VIABILITY SOCIETY CONFERENCE ABSTRACTS Expertise in Wound Management The following abstracts are taken from papers presented at the 2004 Tissue Viability Society Conference held in Torquay on April 20 and 21 2004. These abstracts have not been subject to peer-review. Free paper: Quantifying tissue viability in the community: part one - pressure damage Chaloner D, Stevens'" Roberts 5, Walsall Teaching Primary Care Trust, Franks P, Thames Valley University District nurses provide most of the professional nursing care given to patients who are receiving treatment in their own home. The demand for these services has escalated as the elderly population increases and the drive to promote earlier hospital discharge and the reduction of inappropriate hospital admissions increases. Domiciliary specialist care is also becoming more common and an increasing number of patients with acute conditions or degenerative disease are being cared for at home. Given these pressures one primary care trust agreed to review the way in which the district nursing service was managed and delivered. One of the recommendations was to systematically profile each caseload. This presentation will describe this evaluation of district nursing activity in Walsall Primary Care Trust. Major categories analysed were: • Leg ulceration • Prevention of leg ulcer recurrence • Pressure ulceration • Pressure ulcer prevention • Other wound management • Continence • Diabetes • Palliative care. In total there were 2005 patients being treated and interestingly it was demonstrated that 1619 interventions were relating to tissue viability. This presentation will concentrate on pressure ulcer prevention and management. Of the total sample size 9.5% had current pressure ulceration. However, 20.5% were receiving interventions for pressure ulcer prevention. These audit outcomes will demonstrate prevalence by caseload and catchment population, pressure damage by age and gender, ulcer site. Grade of ulcer, risk levels by age and gender, and resources and prevention strategies in use. The same information will be provided for the at-risk ulcer- free population. © Tissue Viability Society JOURNAL OF TISSUE VIABILITY VOL 14 NO.4 OCTOBER 2004 This work has indicated the level of service provision for patients with pressure ulcers and those at risk. It has also reinforced the awareness that this client group has intensive requirements for preventative equipment and the huge burden that patients at risk of pressure ulceration comprise compared with patients with actual tissue damage. Free paper: A comparison of pressure ulcer risk assessment tools in palliative care Hampton'" Brosnen C, Hmpley 5, Linden A, Kensington and Chelsea Primary Care Trust Aim: To investigate which of three pressure ulcer risk assessment tools is most suitable for assessing the risk of patients admitted to a palliative care unit. Method: A prospective cross-sectional study with data collected at admission and discharge or death on all consenting patients admitted over a 12-week period. Data included the risk assessment score of the currently used Waterlow tool, the Walsall tool used by the community nurses, the Hunters Hill palliative care tool!, skin condition and mattress in use. Results: A total of 74 patients took part, of whom 38 had pressure damage on admission, although for 68% this was grade 1. The Walsall tool had the highest sensitivity (89%), compared to the Waterlow (34%) and Hunters Hill (18%). The Hunters Hill tool had the higher specificity at 83%, compared to the Waterlow tool (67%) currently in use. The Kappa test indicated substantial agreement between the assessed risk and the nurses' clinical judgment of risk in relation to the Walsall tool (Kappa = 0.75) and the Hunters Hill tool (Kappa = 0.73), but only fair agreement for the Waterlow tool (Kappa = 0.38). The Waterlow tool was the least appropriate risk assessment tool for this group of patients. There was little difference between tlle Walsall and Hunters Hill tools. The unit has now implemented the Hunters Hill tool as it was designed for palliative care patients. However, this tool raised some difficulties that require further work, for example, it has no 'no risk' category and further debate is required about real differences between 'high risk' and 'very high risk' categories. Chaplin 1. Pressure sore risk assessment in palliative care. Joumal of Tissue Viability 2000; 10(1): 27-31. 149
