Authors (including presenting author) :
Cheng KL(1), Lai YLA(1), Pang YK(2), Yuen SL(1)
Affiliation :
(1) Department of Surgery, Queen Elizabeth Hospital
(2) Stoma and Wound Nurse Clinic, Department of Surgery, Queen Elizabeth Hospital
Introduction :
Pressure injury (PI) after surgery affect thousands of people worldwide1 while the prevalence of post-operative pressure injury was 18.96%2. The development of painful open wound, risk of infection, lengthen hospital stay and increase treatment cost are burden of the patients, caregivers and healthcare system2. Collaborative team approach with appropriate interventions can effectively reduce hospital-acquired pressure injury (HAPI)3.
Objectives :
To enhance patient care outcomes, staff education, and reduce number of HAPI.
Methodology :
Executed sustainable multi-strategies on PI prevention in all surgical wards such as recruited PI Prevention (PIP) Link nurses and conducted regular service improvement meetings; applied prophylactic dressing over bony prominences to high-risk cases and adopted tailor-made skin assessment form; provided pressure redistributing supportive devices e.g. alternating air mattress, heel protectors, protective foam dressing under medical devices, etc.; enhanced supervision and performance in repositioning within 2-4 hours; performed stringent head-to-toe patient skin and risk factors assessment; alert staff with related bedhead panel signage; completed record and documentation correctly and supplemented with clinical photo; given educational pamphlets to patients and relative with update on any PI wound status; initiated regular cross-ward rounding and audit on PI preventive measures compliance; launched department PI Investigation Form and guided PIP Link nurses to report and evaluate the incidences of PI; consulted department wound care nurses for wound management advice, referred allied health professionals to boost up nutrition and mobility function and reported to doctor of the wound progress; conducted scenario-based simulation training workshops to nurses and supporting staff on appropriate skin assessment and PI prevention and management; run stop-PI Day activities and published innovative poster with catchy slogan to arise staff’s awareness.
Result & Outcome :
From 2Q2022-2Q2024, eight service improvement meetings were conducted among 24 PIP Link nurses to discuss various PI prevention strategies and disseminate them to department staff. 160 HAPI cases in the measured period were deeply reflected on the cause, management and service improvement plan. Audited 120 cases receiving appropriate care on PI prevention and reviewed 216 times on PI prevention documentation compliance. Two identical department-based PIP training workshops had been conducted in 2023 and trained up 80% nurses and 100% supporting staff. In the pre and post-test evaluation indicated 17% and 36% improvement in staff’s knowledge on PIP measures. The department PI rate was significantly dropped from 3.83 (2Q2022) to 0.77 (2Q2024) through 2 years dedicated teamwork accomplising around 80% PI incidence reduction. Several surgical wards had recorded zero HAPI despite the bed occupancy rate was above 100% that was rarely seen before, and the monthly PI rate could be dropped to 0.59 in May 2024, which was the lowest in two years.
