Hopefully by now you are aware the ANMF is running a national campaign to have staffing ratios established across the aged care sector – public and private residential facilities.

The publicity for this campaign has flushed out a range comments from aged care providers, nurses, care workers, elderly people (both those in care and potential consumers of aged care), and informal carers (family/friends).

Much of this feedback has been positive, recognising that elderly people in residential facilities are there because they require 24 hour care and a skills mix that meets their care needs. Some comments, however, have led us to provide information to correct misconceptions.

A particular case in point, just as the title signifies, is that pressure injuries are not inevitable. While our members will know this fact, we provide the following to arm you with information so that you can refute this fallacy should you encounter it in your workplace.

A pressure injury (PI) is a localised injury to the skin and/or underlying tissue, usually over a bony prominence, resulting from sustained pressure, including pressure associated with shear. The most common bony prominence is the sacral area (the area at the base or bottom of the spine) and heel, but they can develop anywhere on the body (National Pressure Ulcer Advisory Panel 2014).

Pressure injuries are a major contributor to the care needs of people in aged care, but this does not have to be the case. Most pressure injuries are preventable if appropriate measures are implemented, and this is the crux of the issue. To implement these strategies effectively, evidence from large-cohort studies undertaken on quality of care clearly shows there must be sufficient numbers of staff and the right skills mix of those staff (Aiken, 2016).

While immobility can cause pressure injuries, risk factors are not restricted to decreased mobility. Other factors include: poor nutritional status, skin integrity, age and the level of oxygenated blood supply to pressure points. A pressure injury can occur in a person with any or all of the associated risk factors and can commence in any setting and in people of any age.

Nurses in all health and aged care settings are well aware of the strategies to prevent pressure injuries, which involve:

• initial and ongoing risk assessment of all persons in care;
• implementation of prevention strategies including comprehensive skin inspection and repositioning of the person at regular intervals;
• early identification and analysis of causal factors in the event of pressure injury development; and
• immediate intervention including selection of appropriate pressure relieving devices.

Some aged care providers suggest anyone can use available risk assessment tools to identify and rate a person’s potential for pressure injury and implement treatment.  However, while such tools may assist decision making, they can not be relied on in isolation of knowledge and clinical assessment conclusions.

This is precisely where the importance of having the right skills mix in aged care comes into play.

Research commissioned by the ANMF in 2016, in conjunction with Flinders University and the University of South Australia, provides evidence that a skills mix of registered nurses - 30%, enrolled nurse - 20% and personal care workers - 50%, is the minimum requirement “to ensure safe residential and restorative care” (Willis 2016).

Registered nurses are equipped with the knowledge, backed by an evidence base, to undertake a comprehensive assessment of potential for pressure injury and commence appropriate preventative measures, and/or, to institute required wound management systems for established pressure injuries.

It is essential that aged care providers acknowledge and implement evidence-based pressure injury prevention and management strategies. Registered nurses are qualified to be the clinical leaders for determining the complex care required to prevent and manage pressure areas, including co-ordinating and monitoring care management plans in conjunction with enrolled nurses and delegating aspects of care to personal care workers.

Instigating solutions and monitoring for compliance with best practice requires ongoing education and an awareness of all risk factors associated with pressure injuries.

Pressure injuries will undoubtedly occur without  the right skill mix and number of registered nurse, enrolled nurses and carers. To prevent this from happening we need: Ratios in Aged Care – Make them Law Now.

Julianne Bryce, Elizabeth Foley and Julie Reeves
Federal Professional Officers

References

Aiken,L,A., et al. Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality and Safety. November, 2016. Vol 26 (7).

National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Australia; 2014.

Willis, E., Price, K., Bonner, R., Henderson, J., Gibson, T., Hurley, J., Blackman, I., Toffoli, L and Currie, T. 2016. Meeting residents’ care needs: A study of the requirement for nursing and personal care staff. Australian Nursing and Midwifery Federation.