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Donna Morris,Leah Panniers, Gareth Turtle, Dawn Daniel, Carly Marsh, Bethan Murphy and Susan Reed

Cwm Taf Morgannwg University Health Board


The Balance of Posture Versus Pressure

Through 2019-20 started to identify through MDT working that issues of pressure management and damage in CYP were not being identified, managed or escalated in a robust and transparent manner. Community Children’s Nursing Services, Tissue Viability Nursing Services, Paediatric Physiotherapy and Paediatric Occupational Therapy agreed to start looking at this together but had no defined timescales for the project.

COVID 19 Hits all workstreams halted, all scheduled care services closed down and children sent home from school.

Started to identify within the first 8 weeks of CYP being at home that we were all having more conversations with families around issues with pressure damage and skin care. We went from having approx. 2 cases a year reported to identifying 4 CYP with single or multiple areas of skin breakdown due to pressure damage in 8 weeks.

Questions we asked ourselves:

  • Were we seeing our own pandemic?
  • Had we been blind to what was out there and therefore under reporting?
  • Do school and other settings do essential work in keeping skin healthy?
  • Do parents/carers know what to do?

Project Aims:

Develop and produce a clear, evidence-based process to reduce the risk of the development of pressure ulcers in children and young people, through early identification, management and escalation, using a range of information and intervention for children, young people (CYP) and their families and carers, as well as the health care professionals that support them.


  • Clarify and promote the responsibilities of health care professionals in the identification, management and treatment of pressure ulcers.
  • Produce and deliver training packages that support autonomy in CYP, their families and carers and increases awareness in healthcare professionals of the need to reduce the risk of and prevent the development of pressure ulcers in CYP.
  • Produce written information that helps CYP, families and carers prevent and identify pressure ulcers and when and how to escalate the need for management, treatment and support across the multi – disciplinary team.
  • Produce robust, evidence-based documentation to support good quality care management and delivery from healthcare professionals


Despite the project being driven by COVID, the restrictions in place posed a range of challenges;

  • Suspension of face-to-face training and meetings meant that progress was hindered by reduction in convening meetings and the roll out of identified and planned training.
  • The relative infancy of digital platforms for meeting and training opportunities in the health board meant challenges for access and digital literacy
  • Redeployment of some project members to support the critical pandemic need between December and March resulted in difficulties in gathering and assuring information and material, pivotal to the project
  • A culture of poor recognition of accountability amongst professional registrants, in both nursing and therapy disciplines, resulted in a slow increase of awareness of responsibilities in the identification and management of pressure ulcers in CYP.
  • A number of unplanned movements between roles, amongst nursing professionals, resulted in a change of priorities in workload and commitments, inadvertently slowing progress of the project.

Key Outcomes:

Development and delivery of 4 training packages:

  • Package A – Education for parents around tissue viability and postural management
  • Package B – Education for school staff around tissue viability and postural management
  • Package C – Education for health care staff (non-qualified nursing) around tissue viability and postural management
  • Package D – Education for qualified nursing staff around tissue viability and postural management

“The training was a very informative session that covered all aspects of postural management for CYP with complex health needs. Awareness of responsibility was highlighted as everybody’s business with accountability, in part, evidenced for a range of professionals as well as parental responsibility.”

Resources developed:

A large number of resources have been developed and we have attached a selection below that are appropriate to share.

A postural care information leaflet:

Postural Care

A positioning passport:

My positioning passport

Inspection checklist:

SSKIN Inspection Checlist

Information for parents and carers on pressure ulcer prevention:

Pressure Ulcer Children's Booklet

A Nursing and therapy skin assessment checklist:

Pressure Ulcer Prevention Management Care Plan

Development of a shared nursing/therapy algorithm for the assessment, prevention, treatment and review of pressure ulcer risk and management for Children and Young People in Community Settings:


We have remained committed and determined to this project through a very challenging year, ensuring robust collaboration to improve the outcomes for our children and young people.

Next Steps:

  1. Roll out the training packages across schools and to parents
  2. Role out training to the Community Paediatric Nursing Team, Paediatric Physiotherapy team, Paediatric Occupational Therapy team
  3. Completion and then adoption of the Multidisciplinary Clinical Protocol to aid in the Identification and Robust Management of Pressure Risk and Damage in Children and Young People with Complex Needs in the Community
  4. Uploading of all resources to Health Board webpages
  5. Development of an exemplar report to publicise the protocol and resources across the Health Board
  6. Audit of nursing and therapy records against Multi-disciplinary Protocol
  7. Including within the Paediatric Journal of Excellence for all new Paediatric Nurses

Our Exemplar Experience:

Participating in the Bevan exemplar has allowed us to learn more about each other’s professions and what we have to offer each other and the Children and Young People of Cwm Taf Morgannwg Health Board.


Twitter: @CwmTafMorgannwg; @CTMUHBOT