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Detecting a Pressure Ulcer before It Appears

Posted by on in Focus on Disability
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Nurse innovator hopeful of pressure ulcer monitoring technology potential

A leading tissue viability nurse hopes that plans to develop an electronic tool for recording pressure ulcers for wider use across the NHS could transform the quality of data and aid efforts to improve prevention and treatment.

Nurse consultant Mark Collier, lead nurse for tissue viability at United Lincolnshire Hospitals NHS Trust, is the brains behind the Pressure Ulcer Notification Tool (PUNT), which has helped significantly reduce hospital-acquired pressure ulcers at the organisation, saving millions of pounds.

“We’ll actually be comparing like with like instead of apples with pears”

Mark Collier

At the moment, the online reporting, recording and monitoring tool can only be used on the trust’s intranet. But it has recently been licensed by medical technology company Bruin Biometrics, which plans to develop it for use by any hospital or community service in the UK.

Mr Collier, who was a founding member of the Wound Care Society, said widespread use of the system across the NHS had the potential to dramatically improve the accuracy of data on pressure ulcers.

At the moment, he maintained that a significant number of ulcers were not being reported, with variations in the accuracy of various recording systems used at different trusts.

“It is not easy to collect incidence data and I just want those who may be struggling to have any easy way of producing data that is actually reliable,” he said. “If my data turns out to be worse than the next trust I can live with that, as long as we are counting in the same way.

“What I can’t live with is people telling me there are no pressure ulcers in their hospital, when I know they are not counting them properly,” he told Nursing Times.

“A significant number of pressure ulcers are not currently reported – most will only report the minimum and a number are misclassified either as a moisture lesion or given the wrong grade – usually lower than it should be,” he said.

“I just want those who may be struggling to have any easy way of producing data”

Mark Collier

He said variations in reporting risked painting a picture where trusts with more accurate records came out worse than those taking a less systematic approach.

“You can feel like you are being penalised because you are being honest,” he told Nursing Times.

PUNT, which is used by nurses across United Lincolnshire’s four hospital sites, was launched in 2004. Under the system, each pressure ulcer has a unique ID allowing clinicians to swiftly track their history and removing the risk of “double counting” of ulcers when patients move between wards.

It alerts nursing teams when assessments are needed – for example if a patient has been transferred from another setting or an existing patient needs an ulcer re-assessed – and allows matrons to keep a close eye on performance regarding pressure ulcers on their wards, compared to others.

Since PUNT was upgraded in 2011 to make it more user-friendly, the trust has seen the incidence of hospital-acquired pressure ulcers drop by nearly 40%.

Ulcer rates have dipped as low as 0.9% – compared to a national average of between 4-6% – and currently stand at 1.5% for all categories of pressure ulcer, with most being the less serious stage 1 and 2 pressure sores.

“You can feel like you are being penalised because you are being honest”

Mark Collier

Meanwhile, Mr Collier estimates the trust saved more than £1.5m in 2014-15 alone, due to timely reporting and intervention.

Plans to make PUNT available more widely will include the creation of a mobile phone app. The ultimate aim is to enable pressure ulcer data to be easily reported and accessed by both hospitals and community services, and shared and compared across trusts and the NHS as a whole, he said.

“Then, when we are comparing numbers across the UK, we’ll actually be comparing like with like instead of apples with pears,” said Mr Collier.

The ability to share up-to-date information about ulcers between acute and community services was important, he added.

“If community nurses have an app on their phone, they can record the data for that patient and it will go back to a central point,” he said.

“When we discharge a patient and say, they have a pressure ulcer, that’s all we’ll need to write, because community can key in the patient’s details and bring up the report and see the whole history of the ulcer,” he noted.

The aim is to pilot the system in five areas within the next 18 months – including at United Lincolnshire Hospitals, which hopes to work with Lincolnshire Community Health Services NHS Trust on the trial.

Bruin Biometrics plans to incorporate use of its ground-breaking SEM (sub-epidural moisture) scanner – previously featured in Nursing Times – into the digital system.

The hand-held device, which was conceived by a US pressure ulcer specialist nurse and has been trialled in the UK, is designed to detect the early warning signs of pressure-related skin damage days before it is visible to the naked eye, allowing nurses to take swift preventative action.

Exclusive: Scanner could be ‘game changer’ in pressure ulcer prevention

The new version of PUNT looks set to include a section for nurses to record any scanner readings – if available.

United Lincolnshire, which will be using the scanners as part of the PUNT roll-out project, has previously tested the technology and found it worked well.

Mr Collier said the scanner would be used to “enhance” current assessment methods, such as the Waterlow risk assessment tool.

“Our impression was it was most beneficial in helping us distinguish moisture lesions as opposed to pressure lesions, helping us then take the right path,” he said.

However, he said there were concerns about cost, which Nursing Times believes to be around £15,000 per scanner.

United Lincolnshire Hospitals NHS Trust

The PUNT system

Bruin Biometrics said scanners could be purchased, or hired for a daily rate, and the price varied according to factors, such as the number of scanners and length of any rental agreement.

However, the firm also suggested a scanner paid for itself “if just one pressure ulcer is prevented”.

“We are happy with the technology and like the product but, from a purely economic point of view, we need a bit more information to show it is cost effective,” said Mr Collier.

“If we have four scanners for each of our four sites, that means only tissue viability nurses can use them,” he said. “But ideally scans should be available on every ward, so it is a question of whether we could afford 60 scanners.”

The scanner has been tested by other UK trusts and by independent provider Virgin Care, which said the device had helped reduce hospital acquired pressure ulcers at Farnham Community Hospital by about 95% to almost zero during a six-month pilot.

Earlier this year, Virgin Care announced it would be deploying 10 of the scanners – alongside more traditional visual skin assessments – in the first phase of an initiative that could see them used more widely across the community hospitals that the company runs in Surrey and elsewhere in England.

Virgin adopts ‘game changing’ pressure ulcer scanner

It not yet known how the revised PUNT system will be made available to other trusts and the costs or conditions involved. Bruin Biometrics said it was still working out the details.

“Bruin Biometrics has just licensed PUNT and is still conducting research and exploring development and commercialisation options,” said a spokesman for the company.

I came across this article on the Nursing Times website and I have reproduced it. I hope that the author is okay with me doing this. I think it's very important that people hear about this. A device like this could be a godsend for lots of wheelchair users who are at risk from developing pressure ulcers, especially those of us who have a history of skin problems.

Just imagine if there was a device available in all communities that could almost detect a pressure ulcer before it started? Even if the community nurses couldn't afford to buy something like this, your local hospital could have one available for outpatients if need be.


I live on the south-west coast of England in a small town called Brixham.  I been confined to a wheelchair 1986 after breaking my neck in a swimming pool accident.  Computers are my saviour and I spend most days doing one thing or another on my PC.  Other interests I have include angling and amateur radio.  I also run a website and forum dedicated to looking after and caring for the Oscar fish cichlid


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Guest Tuesday, 25 September 2018