Authors (including presenting author) :
Chan SKA(2), Lo WC(2), Choy YM (2), Ho HY (2),Wong WYN(2),Sin ML (2),Kwan SCW (2),Pi SS (2),Lee MM (2),Wong FS (2), Hui WM (2), Ksang KK(5), Pang YK(6), Tam KFS(1), Poon WYM(3), Tsui SKA(3),Chan YPB(4), Chan YLE(7), Leung PF(8)
Affiliation :
(1) Medicine Department, Hong Kong Buddhist Hospital, (2) Nursing Department, Hong Kong Buddhist Hospital, (3) Physiotherapy Department, Hong Kong Buddhist Hospital, (4) Occupational Therapy Department, Hong Kong Buddhist Hospital, (5) Orthopedics & Traumatology Department, Queen Elizabeth Hospital, (6) Wound & Stoma Care, Kowloon Central Cluster, (7) Occupational Therapy Department, Wong Tai Sin Hospital, (8) Dietetics Department, Queen Elizabeth Hospital
Introduction :
According to the Hospital Authority Nursing Quality Annual Report, the average hospital acquired pressure injury (HAPI) rate of Hong Kong Buddhist Hospital (HKBH) was 1.125% in 2016. In bench marking with 0.47% overall HAPI rate in same Group 2 hospitals, there was a great disparity (Figure 1). In the report, buttocks and heels were reported as the top common locations of HAPI. As such, these two locations should be focused as two target locations for pressure injury prevention. In the report, the HAPI rate was further broken down into different specialties. Palliative patient got the second highest 3.83% of HAPI rate among different specialties. As 25% of HKBH patients were palliative patients, they were then regarded as our target patient group for pressure injury prevention.
Objectives :
1. To avoid the risk of developing pressure injury in patient. 2. To continue quality improvement in pressure injury prevention. 3. To uphold the performance in quality and safe patient care.
Methodology :
In view of this, target approach on locations and patient group on pressure injury prevention was adopted on top of existing multidisciplinary approach. Besides, 4-Ms Care Bundle, originated from lean management model, was implemented in April 2017. 4-Ms represented MAN, MACHINE, MATERIAL and METHOD. MAN was the right man to a job. It was to strengthen the training on staff and clients. KCC wound specialists including Oncology wound nurses were invited to deliver lectures to nurses on the latest knowledge on pressure injury prevention. Training on supporting staff was focused on bedside training to provide practical tips to relieve pressure on bony prominence on patients’ buttocks and heels. Clients were empowered to engage in pressure injury prevention through leaflets and interactive lectures. 3D model of foot and pressure mapping over buttocks were employed to facilitate client’s understanding. Patient exercise training was reinforced to enhance their ability to reposition their buttocks and heels. MACHINE was the right type of equipment to accomplish the job. It was to employ up-to-date pressure redistributing equipment. Low air loss mattresses, heel free devices and turning wedges were procured to relieve pressure over the buttocks and heels. MATERIAL was the usage of prophylactic dressing and balanced diet to enhance the skin and tissue tolerance to pressure. Besides, phototherapy was used to ensure good microclimate of skin. METHOD was the sequence of steps used for achievement of efficient outcomes. Quick guides on proper application of low air loss mattress, prophylactic dressing and phototherapy were developed. This was the strategy to ensure standard and consistence of care. In addition, Plan-Do-Check-Act cycle of quality management method was adopted to ensure ongoing process monitoring and to accomplish sustainable outcome and value to our patients. Regular silence audits were conducted to rule out any operational defects such as inappropriate application on machine, material or method. Then, improvement works could be conducted afterwards.
Result & Outcome :
1. Drop from 1.125% in 2016 to 0.707% in 2017, to 0.367% in 2018, to 0.158% in 2019, to 0.17% in 2020 and 0.058% in 2021 1-2Q. 2. Drop of 94.9% from 2016 to 2021 1-2 Q in whole hospital In conclusion, target approach together with 4-Ms Care Bundle successfully established a robust and comprehensive pressure injury prevention strategy. Most importantly, the implementation of Plan-Do-Check-Act cycle could guarantee sustainable and valuable outcome to our frail and palliative patient groups.
