Pressure Ulcers - Understanding what went wrong through RCA and PSIRF
This session will consider investigating pressure ulcer incidents within the context of Patient Safety Incident Response Framework (PSIRF) and the new National Wound Care Strategy Recommendations.
Undertaking investigations within your care home or home care team will help you understand what improvements need to be made, if any, to the care being delivered. Demonstrating that this activity is taking place, being acted upon and improving pressure ulcer incidents could support an improved CQC rating.
Learning Outcomes
- Understand briefly how a pressure ulcer is caused
- Be aware of the relevant national documents that guide when to investigate.
- Understand the key actions for prevention
- Understand how to determine which factors led to the development of a pressure ulcer
Meet our Experts
Heidi has been a Tissue Viability Nurse since 2002. Her interest and passion in the prevention and management of pressure ulcers began, however, in 1987 on registering as a nurse. She has worked in both acute and community care. She is currently the part-time Tissue Viability Services Lead for Hertfordshire Community NHS Trust.
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