Authors (including presenting author) :
Kwong HT (1)
Affiliation :
(1) Department of Anaesthesiology and Operating Theatre, North District Hospital
Introduction :
In NDH, the prevalence rate of pressure injury in prone position in orthopedic surgery is increasing from June 2016 to June 2018. In 2016, there was no incidence of pressure injury. In 2017, there were 5 incidents of pressure injury among 112 prone position cases. The incident rate was 4.46%. Among these 5 incidents, 2 (1.79%) were classified as stage 2 pressure injury. The incident rate was further increasing in 2018. In the first half of 2018, there were 5 out of 60 prone position cases found to develop pressure injury. The incident rate was 8.33%. Among these 5 incidents, 2 (3.33%) were classified as stage 2 pressure injury.
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Due to the increasing trend in developing stage 2 pressure injury after prone position in orthopaedic cases, an investigation was initiated to identify the risk factor of developing pressure injury among the orthopaedic prone position cases in NDH OT. An enhancement program was then developed based on the result of the investigation to guide the perioperative nurses and other health care providers to provide adequate pressure relieving strategies for patients being put in prone position.
Objectives :
1.To investigate the risk factors of developing pressure injury among the prone position cases in NDH OT
2.To review the current perioperative practice and identify areas for improvement in order to reduce the incidence of pressure injuries
3.To set up and implement standard of care on pressure injury prevention in prone position
4.To fill the knowledge gap and increase the confidence of the colleagues to perform pressure injury prevention strategy
5.To reduce the incidence of stage 2 pressure injuries
Methodology :
The risk factors of our own clinical setting was investigated. First of all, orthopedic cases in prone positioning were retrieved out using the database in the Operation Theatre Management System (OTMS). Then, patients’ ages, duration of operations, BMI, etc were sorted out. The data was analysed to identify the risk factors.
From August to October 2018, a questionnaire was conducted to assess the knowledge gap among all nursing and supporting colleagues. Based on the data collected, current practice was reviewed. An in-service training program targeted in the knowledge gap was provided to nurses and supporting staff with pre- and post-test comparison. The training contents also included the standard of care in pressure injury which was newly set up in our department. Colleagues’ performance on pre & post positioning pressure point checking was also assessed using a checklist.
Result & Outcome :
Through the data analysis, several risk factors were identified for those pressure injury cases. It included weight, age and length of operation. After implementation of positioning standardization and in service training, nursing and supporting staff were shown more familiar with pressure relieving strategy in prone positioning. And the knowledge of staff in positioning was improved significantly. Mean score of training test was increased from 50% (pre-test) to 98% (post- test). Incident rate of stage 2 pressure injury in first half year of 2019 still remains 8.8%. Conclusion: According to the result, we can conclude that our enhancement program has positive impact on nursing care of positioning. However, statistical result reflected that we still need further investigation and improvement to prevent pressure injury. Because of pressure injury is a multifactorial event, further investigation on external factor, internal factor and exploring other preventive measure are our new direction for our further studies.
