Preventing pressure ulcers: developing a framework of collaborative research and working across partners in health and social care settings

11 January 2018

Yitka Graham, Senior Lecturer in Public Health, School of Nursing and Health Sciences, University of Sunderland and NIHR Speciality Group Lead for both Health Services Research and Public Health: North East and North Cumbria Clinical Research Network; Ann Fox, Director of Nursing, Quality and Safety, Sunderland Clinical Commissioning Group

The PROACT project

Ann Fox and Yitka Graham formed a Sunderland-wide stakeholder group committed to raising awareness of the signs and symptoms of pressure ulcers (PUs) across a wide range of health and social care settings. Sunderland CCG is one of the national vanguard sites which intend to commission a Multispecialty Community Provider (MCP) out of hospital integrated service model. The aim of the Sunderland-wide stakeholder group is to develop  a collaborative research partnership across Sunderland to collect baseline data of current PU prevention practices, then deliver education sessions to staff using recognised tools (React to Red, SSKIN bundle) to minimise variation in working practices, evaluate the knowledge and impact of the intervention on practice. A concurrent, separate series of information sessions will be held with members of the public/family carers. Entitled PROACT, the project is funded by Sunderland Clinical Commissioning Group (CCG), South Tyneside CCG, The University of Sunderland and Smith and Nephew plc.

Pressure ulcer prevention in health and social care settings

It is well evidenced that pressure ulcers are a major burden to the NHS and adversely impact on a person’s quality of life (1). Owing to the variety of care situations outside the NHS, it is often difficult to both understand current practices and capture the true incidence of pressure ulcers occurring in these settings.

Developing a collaborative team across Sunderland

A steering group of partners was formed, including The University of Sunderland, Sunderland CCG, South Tyneside CCG, Tyne and Wear Care Alliance, City Hospitals Sunderland NHS Foundation Trust, South Tyneside NHS Foundation Trust, Sunderland Care and Support, Sunderland City Council, Sunderland Carers Centre,  North East Ambulance Service NHS Foundation Trust, Northumberland Tyne & Wear NHS Foundation Trust and NHS England, bringing together a wide and unique range of perspectives of care across Sunderland. Monthly steering group meetings have allowed the development of  close working relationships in an open forum, sharing of ideas, a greater understanding of the strengths and areas for development within health and social care across Sunderland, and integrating with NHS partners to maximise both expertise and resources.

PROACT to date

To ensure engagement with PROACT, the rationale for the project was presented to care home managers and domiciliary care providers, who were supportive. Next, a series of pre-intervention, anonymous online surveys, developed in collaboration with care providers and tailored to the range of care settings (e.g. residential and domiciliary care) were distributed to managers to ascertain existing knowledge levels, practices and training provision in each setting. The findings will form a baseline of current practices to compare and inform the education sessions, which will be rolled out from February 2018. To prepare for this, we have:

  • Presented PROACT at a Sunderland-wide frailty conference securing written pledges of support from across care providers.
  • Published on pressure ulcers and the CQUIN framework in the Journal of Community Nursing (2).
  • Lit up key landmarks in red across Sunderland for November’s Pressure Ulcer Awareness Day, supported by a press campaign, widely shared across print and social media to raise awareness of PROACT.

Next steps

From February 2018, we will be rolling out the care home and domiciliary care staff pressure ulcer prevention education sessions, whilst concurrently running information sessions for members of the public across the five localities in Sunderland.

PROACT has been adopted onto the NIHR portfolio owing to recent changes in eligibility criteria for research in non-NHS settings. Our collaboration brings together the wider care sector to work together to address health issues affecting our population and build opportunities for nurses, allied health professionals, others working in the care sector, along with members of the public to partake in research in health and social care settings to improve health across Sunderland.


  1. National Institute for Health and Care Excellence. Pressure Ulcers: Quality Standard. London: National Institute for Health and Care Excellence; 2015.
  2. Scott-Thomas J, Hayes C, Ling J, Fox A, Boutflower R, Graham Y. A practical guide to systematic wound assessment to meet the 2017-19 CQUIN target. Journal of Community Nursing. 2017;31(5):30-4.

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