Study to improve pressure ulcer care in children with darker skin

Dr Takawira Marufu, clinical academic nursing research lead at Nottingham University Hospitals NHS Trust, and Professor Joseph Manning, professor of nursing and child health at the same trust and the University of Leicester, are jointly leading the study.

"We hope to have an accurate and reliable pressure injury risk assessment tool for use in all infants and children admitted to hospital"

Takawira Marufu

They hope to find out if current assessment tools for pressure injuries are effective in spotting them in children with darker skin and to create a better alternative.

These injuries normally present as ulcers on parts of the skin near bones, such as elbows and hips, which make contact with beds or wheelchairs for long periods of time. Worn medical devices on children can also cause pressure injuries.

Nurses, healthcare assistants and other clinicians frequently check for pressure injuries in both adult and paediatric patients.

However, current pressure injury risk assessment tools used in hospitals were not, the researchers said, developed with “consideration” for differences in symptoms due to skin tones.

“This means that the current tools may not effectively identify pressure injury risk for those with dark skin tones,” the researchers said.

The nurse-led research project will run for 18 months and, Dr Marufu and Professor Manning hope, will lead to improvements to the existing Braden QD pressure risk assessment tool and address “critical knowledge gaps” in assessments.

Dr Marufu and Professor Manning’s study has been funded by a research grant of more than £250,000 from a National Institute for Health and Care Research (NIHR) programme.

It will run across 10 NHS hospital trusts in England, including at Nottingham University Hospitals, in two phases.

The first phase will involve focus groups with patients, families, healthcare professionals and others to identify “issues which are contributing” to the development of pressure injuries in children with darker skin tones in hospitals.

The second, which will involve 500 children and young people with darker skin who are hospitalised, will test the effectiveness of both modified and unmodified pressure injury assessment tools in spotting the injuries.

“Pressure injuries are a concern and are the cause of real distress and sometimes even long stays in hospital for children and young people – something we really want to avoid,” said Dr Marufu.

“At the end of this study, we hope to have an accurate and reliable pressure injury risk assessment tool for use in all infants and children admitted to hospital. This is why we will include patients with dark skin tones who have so far been under-represented in similar previous studies.”

Professor Manning said he was “extremely excited” to co-lead the project, and added: “We have been overwhelmed by the significant interest and support from local, regional and national providers of NHS hospital care to children and young people who want to participate in this research.

“In a similar approach to our other research, we have worked with children and their families to develop this study.

“We will continue to engage and involve through inclusive approaches children, young people and families in this research and beyond, to ensure it continues to reflect the views and perspectives of the diverse communities we serve.”

Other nurse and midwife-led projects, in recent years, have looked at the issue of skin tone bias and certain conditions not being spotted on patients with darker skin, due to a lack of knowledge or training among clinicians.

One saw a nurse consultant push for the rollout of skin tone cards for staff at London North West University Healthcare NHS Trust to assist in spotting the early signs of pressure ulcers in patients with dark skin.