Innovation in care for children: The Glamorgan scale

December 29, 2008

Jane Willock, Senior Lecture in Children’s Nursing in HESAS has attracted world-wide attention with the introduction of her new Paediatric pressure ulcer risk assessment scale, which she has termed the ‘Glamorgan scale’. This scale is designed as a tool to assist health care professionals to assess the risk of a sick child developing a pressure sore – a particular problem among critically ill children and those with very severe mobility disabilities.

Pressure ulcers (also known as pressure sores, decubitus ulcers, pressure injury) are areas of skin and underlying tissue that have been damaged by pressure or friction. Pressure ulcers can be superficial and appear as red areas on the skin, blisters or shallow areas of skin loss; but can also be deep damage involving muscle, tendons and bone. Pressure ulcers can be very painful; superficial ulcers may take a few days to heal, deeper ulcers may take months to heal and leave significant scars. Pressure ulcers can be caused when an immobile child lies in the same position for a period of time and the tissues are compressed between bone and the surface the child is lying on, this occludes the small blood vessels, reduces the amount of blood supplying oxygen and nutrients to the tissues, and leads to tissue necrosis. Pressure ulcers are also caused by objects pressing or rubbing on the skin, such as splints, pulse oximeter probes, tubes and even tight clothing.

Pressure ulcer risk assessment tools are scales designed to predict which children are at risk of developing pressure ulcers so that action can be taken to prevent them. Before now, most pressure ulcer risk assessment tools for children have been derived from adult risk assessment tools (mainly developed for use with elderly people). Before the introduction of the Glamorgan scale there was no reliable way of predicting which children were at risk of suffering pressure sores or the degree of that risk. The scale makes it possible to predict and prevent this serious problem.

The Glamorgan scale appears to be the only published pressure ulcer risk assessment tool for children that has been developed using statistical analysis of detailed data of the characteristics of children with (n = 61) and without (n = 275) pressure ulcers. Data were collected in 11 hospitals in England and Wales (with a grant of £13590 from the General Nursing Council for England and Wales Trust.

Pressure sores in children, while comparatively rare, have a huge impact in terms of pain and suffering, prolonged complex hospital care and in cost to the NHS. Application of the Glamorgan scale will be useful in indicating to care staff when and what kind of action will be necessary to prevent pressure sores developing in vulnerable children. The new Glamorgan scale is a highly significant development since it has been demonstrated to be effective through rigorous scientific validation procedures; staff can have faith in its effectiveness.

The Glamorgan scale has attracted interest from across the UK and in centres in the US, Ireland, Netherlands, Belgium, Spain, Israel and Australia which are implementing its use. This new practical tool which bears the name of the University of Glamorgan will greatly improve the care, and the experience of care, of the sickest and most at risk children.

For further information please contact Jane Willock Senior Lecturer in Children’s Nursing, HESAS, University of Glamorgan E-mail “jwillock@glam.ac.uk

Tagged: care sciences