Te Puawai
were assessed (KPMG, 2015). Pressure injuries are recorded in the National Minimal data set.
Between 2008 and 2011 coders recorded 12.485 pressure injury events (Blake, 2012).
These variation in outcomes tell us that we actually have no idea whether or not pressure injuries
are a burden for the New Zealand healthcare system. We also conclude that to some authorities
there is an under reporting, particularly to those who have the obligation to report publicly. These
differences in outcomes are confusing, inhibit learning and encourage us to keep pressure injuries
“literally under the covers”.
Suggestions for moving forward
Before we are able to move forward we need to know where we are. This requires the collecting of
reliable data on pressure injuries. Without repeating the discussion about measuring the burden of
pressure injuries by prevalence or incidence, it is evident from the literature that prevalence is the
most frequently used method to do so. Pressure injury prevalence studies are carried out in a
number of DHBs in New Zealand but what is lacking is agreement to adhere to a robust national
data collection method and analysis strategy. This is of critical importance to create a national
pressure injury data set from which learning can take place to benefit the whole health care system
rather than a few facilities or DHBs.
Moving forward also includes following Donnabedian’s model and measuring pressure injury
structure, process and outcome indicators. Focussing purely on outcome at a national level brings
polarisation between those that do well and those that do not do so well. Answering the why
question remains the most important ingredient for motivating change. There might be a difference
in frequency in measuring the different types of indicators. At structural level changes will not
happen as quickly as they do at client level. In order to answer the “why” question effectively,
outcome measures always need to be accompanied by process measures. The level of adherence
to pressure injury prevention protocols assists in explaining the effectiveness of the prevention
strategy.
A recent NZ proposal to use the NHS Safety Thermometer as an instrument to measure the
burden of pressure injuries for New Zealand violates this principle as it only measures the
outcome. We note a recent published critique comparing a number of pressure injury reporting
systems in the UK which included the NHS Safety Thermometer. All showed a high level of under
reporting when audited according to the golden standard (full skin inspection of the client by two
independent qualified clinical members of staff) (Smith, Nixon, Brown, Wilson, & Coleman, 2016).
This again relates to adhering to the importance of a robust method of data collection.
Moving forward includes transparency. Transparency for health care consumers but also for Health
Care Professionals. Consumers need to know which facilities adhere to pressure injury structure
and process best practices that are supported by the guideline and which haven’t. Many
consumers are becoming more and more healthcare literate and by pr