What are the quality indicators in wound care?

This paper discusses quality indicators that relate to wound care. As clinicians will be assessed against national quality indicators from April 2010, it is important for carers working in tissue viability to gain an understanding of what they are. The Darzi report (Department of Health, 2008) identified that high quality care for patients is an aspiration that is only possible with high quality education and training for all staff involved in NHS services. Continued education and promotion of quality in the field of tissue viability will be more attainable if the NHS, higher education institutions and industry strengthen their partnerships

Tissue viability: the QIPP challenge

In the new NHS the effectiveness of care provision needs be demonstrated, with healthcare practice being aligned to priorities for quality and true measurements of care recorded. The Department of Health (DH) and both the previous Labour and present coalition Government, have identified the need to maintain and develop quality in healthcare. One key area where efficiency savings can be made is within tissue viability services. For example, the DH1 set out its ambition to eliminate all avoidable pressure ulcers in NHSprovided care and the National Patient Safety Agency2 selected the prevention and treatment of pressure ulcers as one of its “10 for 2010” plans to reduce levels of harm in ten high risk patient safety areas. Efficiency savings and elements of the quality agenda, most noticeably Quality, Innovation, Productivity and Prevention (QIPP) have become synonymous with healthcare. Most recently the DH published the challenges and opportunities to health care providers and commissioners to meet the quality agenda, ensuring that efficiency savings are made to allow reinvestment.3,4 The DH operating framework clearly identifies the requirement for the involvement of patients and the public when planning services, allowing them to understand how and where their money is being spent and offering greater choice and control of services. The key is shared decision making, summed up by the phrase “no decision about me without me.” Integral to this, is how the quality and productivity challenge will be met; securing re-investment to meet the demand and improve quality and outcomes. The Government plans to allow patients to rate hospitals and clinical departments according to the quality of care they receive. In addition there will be a focus on personalised care that reflects individuals’ health and care needs, supports carers and encourages strong local partnerships. Patients will be in charge of making decisions about their care and will be able to choose which consultant-led team, GP and treatment they have.3 Empowering patients to become involved in choosing their treatment through integrated care can help them achieve greater control.5 The GP Consortia will look after an £80 billion budget and by 2012 will take over responsibilities from Primary Care Trusts (PCTs), including leadership of the existing QIPP initiative. This initiative will continue with even greater urgency, but with a stronger focus on general practice leadership

The Quality Agenda: what does it mean for tissue viability?

The NHS quality agenda has been discussed, debated, explored and highlighted over the past year in an effort to meet the challenges laid down by the Department of Health (DH). The terms quality accounts, innovation, productivity and prevention (QIPP), and the Commissioning for Quality and Innovation (CQUIN) payment framework should by now be familiar to most clinicians. The CQUIN framework aims to place quality improvement and innovation at the heart of negotiations between commissioners and providers to ensure that local quality improvement priorities are discussed at board level. The CQUIN payment framework also stipulates that a proportion of the income paid to healthcare providers is conditional on quality and innovation. This will help to create an NHS where quality is the organising principle, as set out in High Quality Care for All (DH, 2008). There are in excess of 200 new indicators that make it essential for tissue viability clinicians to benchmark their work against that of their peers. Each strategic health authority (SHA) has identified quality initiative schemes and indicators based around four sectors — acute, community, mental health and ambulance services. The Chief Nursing Officer for England has produced eight high impact action themes for nursing and midwifery, including: ‘Your skin matters: no avoidable pressure ulcers in NHS-provided care.’ Additionally, the Leg Club social model, which has been designed for use in patients with leg ulcers, has been identified by the DH as an area of good practice for its approach to quality care. The DH document NHS 2010–2015. From Good to Great (DH, 2009) clearly states that there will be ‘safer care for patients, who can be confident that they will be protected from avoidable harm’. It highlights pressure ulcers as an area that needs to be addressed and insists that the tariff payment system will not reward poor quality or unsafe care. Penalties can be applied to those areas that do not meet quality or patient satisfaction outcomes, and there is an expectation that over time up to 10% of trusts’ income could be dependent on patient experience and satisfaction. However, tissue viability is not always recognised as a speciality and clinicians need to ensure that it is seen as a discipline that impacts on other areas, such as nutrition, pain management, infection and medicines management. In the future NHS, quality is going to be paramount, but what support will tissue viability practitioners receive in meeting these targets and indicators

What are the indicators of quality in wound care?

To understand and adapt national healthcare language in Europe to evaluate quality of service provided in wound care. Methods: A systematic review identifying and exploring relevant United Kingdom (UK) documents relating to quality; aligning to the domains of quality – patient safety, effectiveness and patient experience; tissue viability and its associated services can raise the awareness of the care provided. By giving true and accurate metrics to the domains of quality, tissue viability would be better positioned to ensure future resources and funding for their service. Results: Patients will be put at the heart of the National Health Service (NHS) through having greater choice and more control of the service provided to them; shared decision making will become the norm, no decision about me without me (DH, 2010). Empowering patients to be involved in the choice of treatment through integrated care can be seen to aid the patient to achieve greater control and self-efficacy over their environment (Wilson, 2010). Conclusions: The NHS vision for the next 5 years is to achieve “Equity and Excellence” in healthcare (DH, 2010). The UK Government will enable patients to rate hospitals and clinical departments according to the quality of care they receive. There will be a focus on personalised care reflecting individuals‟ health and care needs, supporting carers and encouraging strong local partnerships. Although this ethos is projected in the UK health care arena, its underpinning philosophy is relevant to the international health care market