Authors (including presenting author) :
Mak CW(1), Chan LY(1), Hui, CP(1), Ma KMK(1), Mok WS(1), Chung PYP(1), Pang PY(1)
Affiliation :
(1) Department of Orthopaedics and Traumatology, North District Hospital
Introduction :
Hospital-acquired pressure injury (HAPI) induced great burden on healthcare expenditure and great patients’ suffering. There were 10 patients developed HAPI, mainly over sacral and heel area, all Stage 2, in the Department of O&T in 2021. They were all rated as high-risk with Norton scale ≤ 14. Thus, it is crucial to reinforce nursing and supporting staffs in screening and providing preventive measures for high-risk patients.
Objectives :
(1) Reduce the number of Hospital-acquired pressure injury (PI) in the Department of O&T (2) Enhance Nursing & supporting staff’s awareness on PI prevention (3) Achieve a behavioral change in practice on PI prevention
Methodology :
(a) To identify high-risk patients in the department, all patients are screened by Norton scale on admission, on regular basis (every Saturday) and whenever patients’ condition change. For those with high PI risk (Norton scale ≤ 14), ‘1.2.3.4 Stand by You for PI Prevention’ program was implemented: (1) One overhead PI prevention signage; (2) Two pressure relieving devices - heel protectors and turning wedge, Twice-a-day skin inspection; (3) Three pressure points checking - two heels & sacrum; (4) Four hours regular turning. (b)The program was introduced to nursing and supporting staff in regular department meeting before implementation. (c) PI prevention kit including the above-said materials was stand-by for nursing and supporting staff, which was given right away to high-risk patients. (d) Cubicle nurse provided 1.2.3.4 PI preventive measures to high-risk patients timely and documented on integrated progress sheet by attached card reminder. (e) Shift in-charge checked the compliance of providing PI preventive measures to all high-risk patients every shift and recorded on assignment book.
Result & Outcome :
The number of HAPI in the Department of O&T decreased to 5 by the end of 2022, which achieved 50% reduction comparing to previous year. During three weeks audit period, total 242 patients were reviewed. All of them were screened upon admission and 236 patients were assessed on regular basis (every Saturday), staff’s compliance rate was 100% and 97.5% respectively for risk screening. Total 22 high-risk patients were identified during the audit period and staff’s compliance on PI prevention was checked. Furthermore, staff had good compliance on performing regular turning (100%), applying pressure relieving devices (86.4%) and inspecting three pressure points twice-a-day (77.3%). 20 nursing and supporting staff were interviewed. All staff agreed that the kit facilitated them and the card remained them to provide PI preventive measures. Both were convenient to use. Besides, most staff (95%) commented that the program increased their awareness and enhanced their compliance on PI prevention. Meanwhile, one nursing staff pointed out that twice-a-day skin inspection is useful in PI prevention and it should be considered as routine care in the department. Moreover, some of them suggested to invite other healthcare disciplines such as occupational therapist, dietitian to join the program, so as to provide heel protectors and nutrition support to high-risk patients more efficiently. Last but not least, they were also worried that medical device related PI had increasing trend this year, especially PI over both ears caused by surgical mask. Therefore, three pressure points checking could be modified into heels, sacrum and ears.
