Join the Campaign for a Present on Admission flag

When Dr Foster looked into the data around Decubitus Ulcers, otherwise known as pressure sores, a large number of hospital trusts told us they could not distinguish between pressure sores that had developed whilst in hospital care and those that were present when the patient was admitted.

Signatories to the campaign | Join the campaign

By mandating the use of a ‘Present on Admission’ (POA) flag the data can give us a clear picture of not only hospital care but of the wider care sector, including care homes and at-home care. POAs are routinely used in Australia, Canada and by the Medicare and Medicaid Services in the USA.

The NHS Information Centre is reviewing how POAs can be used within the data architecture of HES but this a complex goal and might take some time. This campaign is for an interstitial measure to fill the gap.

Knowing where these pressure sores are occurring will help the NHS address what is a costly, painful and complicating factor. The same thoughts apply to a range of other conditions such as falls and infections.

It is for this reason we are launching a campaign to get the use of POAs mandated and have suggested an option below for comment and discussion. Already signed up are a number of hospital trusts, the CQC, the Royal College of Nurses and others.

On Friday 27 January the Telegraph printed a front page article about the letter to the Rt Hon Andrew Lansley MP by the campaign group explaining what the POA is and why it should be implemented immediately.
Front page Telegraph story
Copy of the letter printed inside

The Nursing Standard also reported on the campaign letter under the title ‘Leading Health Figures push for monitoring system (01/02/12)

One option of how to implement a low-cost, low-resource intensive POA flag

In order to reduce cost and speed the implementation of POAs we have developed, through consultation, a simple system. Code Y95 already exists to note where a condition is ‘Hospital Acquired’. We suggest NHS Connecting for Health develops a new code for ‘Present on Admission’ and mandates the use of either one or the other for the following ‘first round’ conditions. This list could be added to over time:

  1. Stage III and IV Pressure Ulcers
  2. Falls and Trauma
  3. Manifestations of Poor Glycemic Control
  4. Catheter-Associated Urinary Tract Infection (UTI)
  5. Vascular Catheter-Associated Infection
  6. Surgical Site Infection
  7. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
  8. AMI
  9. Stroke
  10. Acute renal failure
  11. GI bleeds
  12. Cardiac/respiratory arrest

Signatories to the Present on Admission campaign


Care Quality Commission:
Cynthia Bower, Chief Executive,
Royal College of Nursing: Dr Peter Carter, Chief Executive and General Secretary
Rt. Hon. Margaret Hodge MP: Chair of the House of Commons’ Public Accounts Committee
Nick Smith MP: Member of the House of Commons’ Public Accounts Committee
Professional Association of Clinical Coders – UK: Sue Eve-Jones, Director,

Avon IM&T Consortium: Sarah Scobie, Head of Information Management                                                                                                      Basildon and Thurrock University Hospitals NHS Foundation Trust: Mark Magrath, Deputy-Chief Executive
Calderdale & Huddersfield NHS Foundation Trust: David Wise, Medical Director
Chesterfield Royal Hospital NHS Foundation Trust: Ian Gell, Medical Director
Doncaster and Bassetlaw Hospitals NHS Foundation Trust: Dr Robin P Bolton MA MD FRCP, Consultant Physician and Medical Director
East Kent Hospitals University NHS Foundation Trust: Julie Pearce, Chief Nurse, Director of Quality & Operations
East Lancashire Hospitals NHS Trust: Catharina Schram, Medical Director
Heart of England NHS Foundation Trust: Dr Ann Keogh, Director of Medical Safety
Liverpool Heart & Chest Hospital: Dr Mark Jackson, Associate Director of Quality
Medway NHS Foundation Trust: Jacqueline McKenna MBE, Director of Nursing
North Middlesex University Hospital NHS Trust: Stanley Okolo, Medical Director
Norfolk and Norwich University Hospital: Anna Dugdale, Chief Executive
Northampton General Hospital NHS Trust: Dr Sonia Swart, Medical Director
Nottingham University Hospitals NHS Trust: Stephen Fowlie, Medical Director
Tameside Hospital NHS Foundation Trust: Philip Dylak, Director of Nursing                                                                                                University College London Hospitals NHS Foundation Trust: Sir Robert Naylor, Chief Executive
Whipps Cross University Hospital NHS Trust: Cathy Geddes, Chief Executive
Wrightington, Wigan and Leigh NHS Foundation Trust: Andrew Foster, Chief Executive