by Alphons Mathew

Poster Download

Background & Problem:

Ward 3B is a 29 bedded Trauma and Orthopaedic ward. There has been an increase in the number of patients admitted with neck fractures. Rigid collars are recommended to limit the movement in the neck and aid healing.

The goal of the Q I project was to reduce the pressure ulcer incidence for patients wearing rigid collars for their cervical fractures. The project was focused on providing an enhanced teaching and training for the staff. As a part of this; we also created a care plan to assess patient’s skin in order to decrease the incidence of pressure ulcers and therefore, improve the compliance.


To decrease the number of pressure ulcers due to wearing a rigid collar in Trauma and Orthopaedic ward, to 50% by December 2019.


To achieve our goal we developed an enhanced training for our nursing team, therapy team and junior doctors on the unit. The patient information leaflet was prepared and given to the patient and family members to increase patient awareness.We used a number of PDSA cycles to improve the issues such as education, staff /patient engagement, ward meetings and prioritising patients on personal care. Audits were performed within the first week of application of the cervical collars to evaluate the compliance.


The staffs are more confident in dealing with cervical collars, performing daily checks and changing the liners. In October 2019, the new care plan was re-audited and the compliance rate improved from 33 % to 100 % with completing the care plan. Also we had 0% collar associated pressure ulcer in ward 3B.

Lessons Learnt:

This project has been shown to improve patient safety as well as improving teamwork and communication in the department. This was an eye opening for our C spine patients and we’ll be developing a cervical collar guideline with the spinal team.

Next steps:

  • Develop cervical collar guidelines with the spinal team
  • Update all staff about Aspen Vista collar and collar care(Surgical/medical and oncology areas)
  • Participate/arrange training session across the trust regarding cervical care.
  • Arrange peer review sessions for cervical collar competency assessments.
Quality Improvement Presenter(s)
Alphons Mathew, Ward sister
Ward 3b,T&O,GRH
Quality Improvement Team
Ward 3B staff
Spinal consultants –Mr. Sundaram, Mr. Shah and Mr. Torrie
Therapy team
T&O Advanced nurse practitioners
T&O Matron-Di Thomas
Ward manager-Deanna Rooney
Orthotic specialist