Pressure ulcer and wounds reporting in NHS hospitals in England part 1: Audit of monitoring systems.

UNLABELLED Internationally, health-care systems have attempted to assess the scale of and demonstrate improvement in patient harms. Pressure ulcer (PU) monitoring systems have been introduced across NHS in-patient facilities in England, including the Safety Thermometer (STh) (prevalence), Incident Reporting Systems (IRS) and the Strategic Executive Information System (STEIS) for serious incidents. This is the first of two related papers considering PU monitoring systems across NHS in-patient facilities in England and focusses on a Wound Audit (PUWA) to assess the accuracy of these systems. Part 2 of this work and recommendations are reported pp *-*. The PUWA was undertaken in line with 'gold-standard' PU prevalence methods in a stratified random sample of NHS Trusts; 24/34 (72.7%) invited NHS Trusts participated, from which 121 randomly selected wards and 2239 patients agreed to participate. PREVALENCE OF EXISTING PUS The PUWA identified 160 (7.1%) patients with an existing PU, compared to 105 (4.7%) on STh. STh had a weighted sensitivity of 48.2% (95%CI 35.4%-56.7%) and weighted specificity of 99.0% (95%CI 98.99%-99.01%). EXISTING/HEALED PUS The PUWA identified 189 (8.4%) patients with an existing/healed PU compared to 135 (6.0%) on IRS. IRS had an unweighted sensitivity of 53.4% (95%CI 46.3%-60.4%) and unweighted specificity of 98.3% (95%CI 97.7%-98.8%). 83 patients had one or more potentially serious PU on PUWA and 8 (9.6%) of these patients were reported on STEIS. The results identified high levels of under-reporting for all systems and highlighted data capture challenges, including the use of clinical staff to inform national monitoring systems and the completeness of clinical records for PUs.

[1]  T. Brennan,et al.  Incidence and types of adverse events and negligent care in Utah and Colorado. , 2000, Medical care.

[2]  Jane Nixon,et al.  Reliability of pressure ulcer classification and diagnosis. , 2005, Journal of advanced nursing.

[3]  C. Rivers,et al.  The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients , 2013, BMC Nursing.

[4]  J. Tanner,et al.  A benchmark too far: findings from a national survey of surgical site infection surveillance. , 2013, The Journal of hospital infection.

[5]  C. Vincent,et al.  Adverse events in British hospitals: preliminary retrospective record review , 2001, BMJ : British Medical Journal.

[6]  Joyce M Black,et al.  Medical device related pressure ulcers in hospitalized patients , 2010, International wound journal.

[7]  J A Cook,et al.  The rise of big clinical databases , 2015, The British journal of surgery.

[8]  J. Wyatt.  The new NHS information strategy , 2012, BMJ : British Medical Journal.

[9]  P. Davis,et al.  Adverse events in New Zealand public hospitals I: occurrence and impact. , 2002, The New Zealand medical journal.

[10]  K. Shojania,et al.  Temporal trends in patient safety in the Netherlands: reductions in preventable adverse events or the end of adverse events as a useful metric? , 2015, BMJ Quality & Safety.

[11]  Kaveh G Shojania,et al.  Trends in adverse events over time: why are we not improving? , 2013, BMJ quality & safety.

[12]  Xiao-Hua Zhou,et al.  Statistical Methods in Diagnostic Medicine , 2002 .

[13]  T. Brennan,et al.  INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED PATIENTS , 2008 .

[14]  L. Donaldson,et al.  An organisation with a memory. , 2002, Clinical medicine.

[15]  M. Patterson,et al.  Why do patients develop severe pressure ulcers? A retrospective case study , 2014, BMJ Open.

[16]  C. Landrigan,et al.  Temporal trends in rates of patient harm resulting from medical care. , 2010, The New England journal of medicine.

[17]  J. Nixon,et al.  Pressure ulcer and wounds reporting in NHS hospitals in England part 2: Survey of monitoring systems. , 2016, Journal of tissue viability.

[18]  Charles Vincent,et al.  Safety in healthcare is a moving target , 2015, BMJ Quality & Safety.

[19]  T. Brennan,et al.  Incidence of adverse events and negligence in hospitalized patients. , 1991, The New England journal of medicine.

[20]  R A Greenes,et al.  Assessment of diagnostic tests when disease verification is subject to selection bias. , 1983, Biometrics.

[21]  Cordula Wagner,et al.  Changes in adverse event rates in hospitals over time: a longitudinal retrospective patient record review study , 2013, BMJ quality & safety.

[22]  C Wagner,et al.  Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study , 2002, Quality & Safety in Health Care.

[23]  S. Sheps,et al.  The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada , 2004, Canadian Medical Association Journal.

[24]  Cordula Wagner,et al.  How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time , 2015, BMJ Quality & Safety.