CNO Summit 2017, Day 1, 1.00pm

1. Strategies for Addressing
Unwarranted Variation in Wound Care
Chief Nursing Officer Summit 2017
Entec Health sponsored workshop
Tuesday 14th March 2017
@6CsLive #cnosummit
@NHSEngland
@entechealth #>>woundcare

2. Strategies for Addressing
Unwarranted Variation in Wound Care
Aims
1. Consider challenges and gaps in best practice and optimal wound care
outcomes
2. Explore opportunities and strategies for reducing variation in wound care
3. Consider value of electronic data capture, introducing Silhouette®
4. Share innovation adoption journey at Central Manchester University
Hospitals NHS Foundation Trust

3. Session Plan
• Clinical Practice perspective
Jacqui Fletcher
Independent Wound Care Consultant, Senior Nurse Advisor – Stop the
Pressure Programme (NHS Improvement), Editor of Wounds UK Journal,
Trustee Pressure Ulcer UK
• Innovation Adoption perspective
Sarah Leo
Innovation Adoption Manager, Central Manchester University
Hospitals NHS Foundation Trust
• Panel Q&A
Jacqui Fletcher, Sarah Leo, Session speakers
Sally Napper, Project Director, NHS England Improving Wound Care
Programme
Achala Patel, Managing Director, Entec Health
You the audience

4. Strategies to reduce variation in
wound care
Jacqui Fletcher
@jacquifletcher3
 Jacqui.fletcher@live.com

5. Session aims
Strategies to reduce variation in wound care:
 Known challenges
 What needs fixing?
 How might we fix?
 Q&A

6. Top 5 known challenges in wound care
1. Clinicians are struggling on a daily basis
2. Drowning in a sea of paperwork and decisions
3. Gaps in adoption of evidence-based practice
4. Variation from optimal practice and ideal pathway
5. Collecting data that has no meaning and serves no
purpose
Carter Report 2015
Kings Fund Report 2016

7. What does this mean for wound care?
 To equip ourselves with effective strategies to reduce
variation in wound care, we need to understand the root
causes of the problem first…..we have evidence we can
consider and action for improvement.

8. What do we know about the causes of
chronicity?
 Pathophysiology
 Immunology
 Biomechanics
 Biochemistry
 Psychology
 Cellular level
 Patient level
 Organisational level

9. Vowden and Vowden 2016

10. What did this research tell us about
why wounds become chronic?
 Patients were not assessed
 Patients did not have a diagnosis
 For leg ulcer patients even when they had ABPI they
didn’t get compression – however some that didn’t get an
ABPI – did get compression
 Patients were ‘managed’ for months or years without
onwards referral
 Less than 50% of the wounds healed within a year
 Referral to specialist services significantly improved the
patients chance of healing

11. In a nut shell…..
 TheVowden &Vowden paper suggests that the majority
of the cause of chronicity is failure in the processes of
care!
 Optimal pathway for right care at right time…
https://www.england.nhs.uk/leadingchange/leading-change-adding-value/lcav-in-action/national-programmes/

12. What are key processes?
 Assessment and diagnosis
 Stop points – stop, evaluate
 Determining end points
Caroline Dowsett
http://www.woundsinternational.com/media/issues/122/files/content_86.pdf

13. What could we do but don’t?
 Consistently assess and measure wounds!
 Good evidence that linear measurement is wildly
inaccurate (about 44%) (Jessop 2005, Langemo et al
2008)
 Good evidence that 40% reduction in size at 4 weeks is a
good indicator of potential to heal (Cardinal et al 2008,
van-Rijswijk, Polansky 1994, Phillips et al 2000,
Kantor & Margolis 2000)

14. Key healing indicator often ignored?
 No one measures surface area properly
 Even if they do they don’t calculate percentage change –
because there is nothing to:
 Prompt them to do it
 Prompt them to do something with the information
 Flag when patients aren’t healing
 Encourage or motivate them to heal the patient

15. Electronic data capture systems
Functionality
 Aim to improve the quality, objectivity and consistency of data
captured
 Simplify and automate management of information supporting
clinical decision making
Value
 Provide real time, quantified wound healing metrics which
confirm response to treatment
 Actionable data to encourage staff to better evaluate the care
provided, both to individual patients and cohorts within a
service.

16. Measuring change over time

17. Benefits of Wound Healing curves
 Increase accuracy of healing prediction
 Early identification of delays
 Early intervention / referral
 Targeting of resources
 Efficiency of treatment
 Cost effectiveness
 Facilitate meta-analysis of multiple studies
 Improved patient outcomes

18. Delivering high quality consistent care
 How do we train our staff?
 “You will sink to the level of your training”
 Pathways of care that use technology to remove barriers
can only assist in standardising care
 Reducing variation improves patient outcomes, reduces
spend and reduces waste
https://www.hee.nhs.uk/sites/default/files/documents/Final%20Imperial%20report.pdf

19. Improving Wound Care Project
• Based on Right Care principles
• WoundTec HTC Health Economic Study provides
evidence base (Guest et al 2015, 2016)
• Clinical Expert Group established April 16 to
scope the project
• Work streams led by clinical experts and
practitioners
• Project Board reports to Leading Change Adding
Value Operational Programme Board

20. Key work streams
Best practice guidance
• Standardised wound assessment
tool
• Education & Competency
Framework for wound care
• React To Red – Pressure Ulcer
reduction
• Improving management of Leg
Ulcers
Adoption drivers
• National CQUIN for wound
assessment for community
providers
• Development of commissioning
guidance for wound care
services
• Development of a Right Care
Economic Analysis of Wound Care
Pathway
• Expert by Experience patient
group

21. Time to lead meaningful change that adds value!

22. Thank You
@jacquifletcher3

23. Transforming Wound Care –
Partnering with the NHS
An Innovation Collaboration
Sarah Leo
Innovation Adoption Manager
Central Manchester University Hospitals NHS Foundation Trust

24. In partnership with:
Royal Manchester
Children’s Hospital
Manchester Royal Eye Hospital
Manchester Royal Infirmary
University Dental Hospital
of Manchester
 Saint Mary’s Hospital
 Trafford Hospitals
 Community Health Services
Our Trust
Updated Feb 2016
Over 1 million
patients
cared for across
secondary,
tertiary and
community services
Over £900m turnover

25. In partnership with:
Our vision
Updated Feb 2016
We aim to
position the
Trust as:
The leading provider of tertiary and specialist services in the North
West
A prestigious internationally renowned centre for research and
innovation
An excellent district general hospital for the residents of central
Manchester
At the heart of the regeneration of Manchester
The best place to train and work
And we are
committed to:
…..Delivering care, treatment and advice that combines clinical excellence
with the highest standards of patient safety, is based upon the best research
and employs the latest clinical technologies…..

26. Assured Access for Innovation Adoption – a
new approach
To define the process for assessing and/or adopting new technologies in CMFT
To align with CMFT vision ‘….to be recognised as leading healthcare; excelling in quality,
safety, patient experience, research, innovation and teaching….’
To align with the wider Devolution Manchester agenda to implement significant changes
across health and social care systems to achieve transformational improvements in health
To implement and evaluate new solutions consistently at pace and scale
A new a Trust-wide approach
Delivering innovation aligned to the needs of the Trust and its Hospitals
Working with frontline clinical staff and innovation partners (including industry)
Facilitating the rapid adoption of relevant innovation into clinical practice

27. Tissue Viability Service
What do we
do:
April – Jan 2015/2016 April – Jan 2016/2017
Grade 1 Grade 2 Grade 3 Grade 4 Grade 1 Grade 2 Grade 3 Grade 4
121 354 8 4 157 ↑ 320↓ 6↓ 2↓
From April 2012, the Infection Prevention and Control (IPC) and Tissue
Viability (TV) nursing teams were integrated under one management
structure. The team provides support/advice/education across 6
hospitals and the community district nursing team covering:
- 1600 beds and
- a community population of 210,000
To date in 2016/17 the TV team have carried our 2827 visits across
acute and community settings (new and follow-up).
The service is seeing a year on year reduction in grade 2-4 pressure
ulcers

28. Team structure
The band 6 practitioners undertake a dual role in both IPC and TV and support the
divisions at the clinical interface. The Band 7 specialist nurse role is dedicated to either IPC
or TV and provides a mentoring role to the band 6 team.
Chief Nurse/Director of IPC

29. • Improved continuity of care across acute/community settings
• Reduction of repetition for patients at each visit
• Improved ability to track healing rates
• Photographic evidence for all cases (including depth measurements)
Drivers for change
Quality of care
and patient
experience
• No standardised approach to wound management across the
Trust.
• Wound assessments are paper-based with no systematic approach
to information management.
The current
system
• Geographical footprint set to increase with proposed creation of a
Single Hospital Service in Manchester
• Upcoming Wound Assessment CQUIN
• Reduction of time spent travelling across inner city footprint
• Appropriate referrals
• Earlier identification of training needs for staff
• Potential to increase formulary compliance
Efficiency
External
drivers

30. The solution
Silhouette
offers:
An electronic wound assessment and information
management system
A digital 3D wound camera, wound assessment
software and an information database
Web-enabled, remote review of wound information

31. The journey so far
Entec Health
approach to
Trustech
Link with
Tissue
Viability
team
GMAHSN
Accelerator
funding
Preparation
of internal
business case
Stakeholder
mapping &
Engagement
Project team
established
Health
Economic
Model
developed
Proof of
concept
evaluation
Successful
trial reported
in annual
report
Initial
business
proposal
written
IT Review
May
2014
March
2017
March
2016
• No systematic approach to innovation adoption until March 2016
• Stakeholder engagement at the right time in the journey
• Integration with existing informatics infrastructure (iPads, EPR
developments)
The
challenges we
have faced:

32. Current status and next steps
Business
Case
Submission
Agree
funding
Procurement
Community
Implementation
Software
installation
Hardware
installation
Report
tailoring
Staff
training
Secondary Care
Implementation
Stakeholder
meeting
Implementation
Planning
Stakeholder meeting – mid-March 2017
Collaborative business case planning - ongoing
Demo of community solution with ARANZ Medical – planned for May 2017
Shared learning - ongoing
March
2017

33. Transformation Goals
Technology-enabled service innovation
 Improved continuity of care for patients across
acute and community settings
 Reduced length of stay in acute settings
 Ability to track healing rates
 Delivery of more targeted education
 Increased formulary compliance
 More efficient use of TV team resource
 Quality baseline data to inform future research
and our quality improvement strategy
What
Silhouette will
enable us to
achieve:

34. Thoughts from the Clinical Team
The introduction of Silhouette will enable
us to deliver a much more efficient
service offering advice and support from
our central location where appropriate
and avoiding unnecessary repetition for
the patient.
Louise O’Connor, Advanced Nurse
Practitioner Tissue Viability
The biggest benefit of implementing Silhouette
at CMFT will be the improvements it will allow
us make to the quality of care we deliver. It will
also help us establish a clear baseline from
which we can continue to improve the service
and enhance patient experience.
Julie Cawthorne, Consultant Nurse/Manager
Infection Prevention and Control/Tissue Viability Nursing Services

35. Panel Q&A
Your questions, insights and observations
welcome!
Panel:
Jacqui Fletcher, Independent Wound Care Consultant, Advisor
Sarah Leo, Innovation Adoption Manager, CMFT
Sally Napper, Project Director, NHSE Improving Wound Care Programme
Achala Patel, Managing Director, Entec Health

36. Further resources
• Copy of this presentation will be available at
www.entechealth.com
• NHS England Improving Wound Care Programme
https://www.england.nhs.uk/leadingchange/lcav-in-action/national-programmes/
• Download paper Electronic data capture for wound care, J.Fletcher, Wounds UK, March
2013
http://info.entechealth.com/electronic-data-capture-for-wound-care-j-fletcher-wounds-uk
• See Silhouette case studies & publications
http://www.entechealth.com/solutions/silhouette-for-clinical-practice/
• Download Silhouette Prospectus
http://info.entechealth.com/silhouette-prospectus-discover-digital-wound-assessment
• Learn more about Wound Care Buddy App solution
http://info.entechealth.com/woundcare-buddy-formulary-app

37. Visit Entec Health @ Stand 17
Digital Wound Assessment,
Reporting, Remote Monitoring Wound Formulary App

38. Ways to connect with us
@entechealth #>>woundcare
@6CsLive #cnosummit
@NHSEngland
www.entechealth.com
www.aranzmedical.com
Call Achala Patel on
+44 (0) 7917 007859
Email:
achalapatel@entechealth.com
Follow Entec Health on LinkedIn
Follow Achala Patel on LinkedIn

39. Thank you for your time
and
enjoy the rest of the conference

40. About Entec Health
About Entec Health
Entec Health is an appointed distributor of Silhouette in the UK.
Entec Health is a specialist healthcare technology business, dedicated to selling, marketing and
supporting innovative technologies and transformation solutions for healthcare innovation. The
company brings products to market directly and also supports companies with market development
consultancy services. The company’s vision is to enhance healthcare quality, outcomes and cost-
effectiveness in partnership with healthcare provider clients and their patients.
www.entechealth.com
About ARANZ Medical
ARANZ Medical is the developer and manufacturer of the Silhouette system.
ARANZ Medical is a leader in digital imaging, 3D modelling and software development for specialist
medical applications.
www.aranzmedical.com
Silhouette, SilhouetteStar, SilhouetteConnect, SilhouetteCentral and SilhouetteLink are trademarks of ARANZ Healthcare Limited