Authors (including presenting author) :
CHEUNG YL, WONG YY, TO WY, LAU YP, CHUNG MC, YEUNG ST, YUEN WK
Affiliation :
Department of Medical & Geriatric (Rehabilitation), Tuen Mun Hospital, NTWC
Introduction :
In 2020, statistics from M&G (Rehab) showed that 50% of stage 2 or above pressure injury (PI) was developed in sacral area. In general, patients with risk of PI, who are identified by Norton Score Scale during admission, should be provided with pressure relieving / redistributing devices such as low air loss (LAL) mattress. By 2020, the number of LAL mattress in M&G (Rehab) increased from 69 to 96. It occupied the total bed stat of M&G (Rehab) about 30%. However, in view of demand more than supply of LAL mattress, a workgroup was formed and a program “Pressure Injury Prevention (PIP) Care Bundle” was developed to prevent sacral injury of patients.
Objectives :
It aimed at the early detection of sacral PI development, and prevention of deterioration of stage 1 sacral PI after admission.
Methodology :
Patients would be recruited into the program if they met any one of the criteria: 1. on Mechanical Ventilation; 2. Norton Score ≤12 AND BMI≤16 AND increased skin moisture and without LAL mattress; 3. with Stage 1 Sacral PI. A protective dressing material, foam border sacral dressing, which is durable for 7 days and water-proof, would be applied to sacral area of the target patients. General PI prevention nursing care was provided as usual. Ward nurse performed daily inspection on the integrity of the foam border sacral dressing and sacral skin condition. The PIP care bundle would be ended once the LAL mattress was available. A pilot program in 4 rehab wards for three months was performed in 4Q/2020. Finally, the PIP care bundle was fully implemented in all rehab wards on 31 May 2021. Continuously training, clinical reference booklet and audit were used for maintaining the program sustainability.
Result & Outcome :
From 31 May 2021 to 31 May 2022, there were total number 40 patients recruited. All of the patients were aged 61 years or above. No significant difference in gender was noted (male: n=19; female: n=21). The majority of patients (72%, n=29) met the requirement of criterion 2. All these patients had Norton Score ≤12 AND BMI≤16 AND increased skin moisture but not yet provided with LAL mattress. Whereas, there were 10 patients satisfied the criterion 3, who had stage 1 sacral PI. There was one patient who met both the criteria 2 and 3 at the same time. 60% of patients (n=24) ended program with LAL mattress provided. Meanwhile, 35% of patients dropped out program due to discharge, transfer-out or death. Two patients developed stage 2 sacral PI and were dropped out due to frequent diarrhea and in critical condition respectively. Overall, 67.5% of patients (n=27) ended or being dropped out the program within one week without any adverse outcome.
After the fully implementation of the program, the newly developed PI rate has decreased by 32% when comparing the data in 2020 (0.14 per 1000 bed days) and 2021 (0.095 per 1000 bed days). Also, a downward trend was observed on the total number of PI (stage 2 or above), which decreased from 18 to 12 cases (33.3%); and the sacral PI (stage 2 or above) decreased from 9 to 7 cases (22.2%).
Total consumption of foam border dressing was 86 pieces for the 40 patients. Average use was 2.15 pieces per patient. The cost of one foam border sacral dressing was HKD $70, by calculation the cost per patient was HKD $150.5.
The result of PIP care bundle was a successful temporary measure for preventing high risk patient developing PI or deterioration of stage 1 PI when pressure relieving device was not available. PIP care bundle enhanced the awareness of ward staff to providing LAL mattress to high risk patients. Beside, PIP care bundle was cost effective as comparing the cost of possible prolong hospitalization, expenses of dressing material and nursing care time, as well as the fathomless physical and suffering of the patient.
