NIHR pressure ulcer programme

AimsReduce the impact of pressure ulcers (PUs) on patients through 1) early identification of patients at risk of PU and improved identification and investigation of patients at risk of progression to severe PUs and 2) the development of methods to capture patient-reported outcomes including health-related quality of life (HRQoL) and health utilities for routine clinical use and in clinical trials. Objectives1. Determine the extent of pain suffering and its role as a predictor of PU development.2. Identify individual and organizational factors which contribute to the development of severe PUs and develop a critical incident/adult neglect investigation methodology for the their review.3. Agree a PU Risk Factor Minimum Data Set and use this to underpin the development, implementation and evaluation of an evidence-based risk assessment framework.4. Determine outcomes important to patients who develop PUs and develop a psychometrically rigorous, patient-reported outcome measure that is reliable and valid, and suitable for use in the NHS.5. Assess the value patients place on the prevention of PUs and develop a rigorous health utility measure. BackgroundPUs represent a major burden to patients, carers and the healthcare system affecting 1 in 10 hospital and 1 in 20 community patients. The financial costs are equivalent to 4% of total NHS expenditure. PUs range in severity from skin erythema to large wounds involving fat, muscle and bone. They can lead to death and their impact on health-related quality of life is substantial. Research objectives were identified by recent systematic reviews (risk factors and PU QOL) and builds upon previous high quality multi-centre research by the team.Research Plans The settings for the research studies include acute hospital, community nursing, spinal cord injury and hospice care environments. Populations include in-patient and community nursing patients with acute and chronic illness. We will piggy-back recruitment onto existing NHS prevalence audits, critical incident monitoring and adult protection review processes.Study 1 Pain: includes a prevalence survey to assess the type and severity of localised PU pain in ‘pressure areas’ and a cohort study to explore the role of pain as an early predictor of Grade2 PU.Study 2 Severe PUs: includes a retrospective study to develop a detailed understanding of the individual and organisational factors involved in the development of severe PUs and develop a critical incident/adult neglect investigation methodology for the review of severe PUsStudy 3 Risk Assessment: is a major implementation project. We will update the risk factor systematic review and using consensus methods and findings from Study 1 and 2, develop a patient level risk factor minimum data set. We will then develop, pilot, evaluate and implement a risk assessment framework.Study 4 Patient Reported Outcome Measure: gold standard psychometric methods will be used to develop and validate a psychometrically rigorous, patient-reported outcome measure of HRQOL in patients with PUs.Study 5 Health Utility Measure: we will undertake a valuation survey and develop a utility algorithm for the patient reported outcome measure developed in Study 4. Research team: applicants combine strong NHS and academic leadership in the PU field with methodological expertise and have a track record of collaboration.Research environment: a successful pan Leeds Tissue Viability Collaboration includes clinical, academic and strategic partnerships. Critical is the network of 13 clinical partners including acute trusts, PCTS, spinal cord injury unit and hospice, located in 3 geographical hubs.Outputs: extent of pain suffering Yr 2; incorporation of pain assessment into HRQOL instrument Yr 3 and risk assessment processes Yr 5; understanding of high risk care environments Yr2; robust critical incident methodology; multi-agency service improvements aimed at promoting patient safety Yr3; an assessment framework based upon a