Authors (including presenting author) :
Emily Lai WS , Tang WH , Ki MO , Tsang CH ,Ada Tsui YC , K Y LAW
Affiliation :
Medical and Geriatric Unit, Our Lady of Maryknoll Hospital
Introduction :
The technological advancement has helped to extend the life expectancy. Older people are frailer than younger. The decreased mobility can result in development of pressure injury (PI). Prevention is better than cure. The comprehensive risk assessment and appropriate measures enhance prevention of PI. Nurses, especially frontline newly graduated staff, play an important role on clinical assessment and patient nursing care in the daily working. Therefore, a ward based continuous quality improvement (CQI) pinpointing newly graduated staff is introduced in order to prevent hospital acquired pressure injury (HAPI).
Objectives :
1. To enhance knowledge competence on PI prevention for newly graduated nurse. 2. To reduce the HAPI.
Methodology :
A work group on prevention of HAPI was set up by second tier wound nurses in male medical ward (N2). A one to one coaching program to newly graduated staff was implemented in September, 2019. “REMIND” Program cue card was introduced on prevention of HAPI in 6 directions. (R=Risk Assessment; E=Education; M=Moisture reduction; I=Inspection of skin; N=Nutrition and D=Device on pressure relieving) (Fig. 1) Besides, “IMMOBILE” was indicated as high risk group on PI for reference. (I=Incontinence; M=Mobility; M=Malnutrition; O=Other disease(s); B=Body weight; I=Inspection of skin; L=Loss of sensation; E=Elderly) (Fig. 2) To monitor the program, pre- and post-program compliance audit on prevention of PI was conducted according to 6 directions in “REMIND”. The staff satisfaction survey after the program was collected. The Plan-Do-Check-Act cycle was adopted as a tool to ensure the ongoing quality improvements. The trend of monthly HAPI rate was the indicator in the program.
Result & Outcome :
The “REMIND” program was started in September 2019. From June to August 2019, total 81 patients had community acquired pressure injury (CAPI). The rates of HAPI were 0 % /per 1000 bed days, 1.88% / per 1000 bed days, and 0.895 % /per 1000 bed days in June, July and August respectively (Table 1 & 2). From September to November 2019, total 59 patients had CAPI. The monthly rate of HAPI was zero from September to November after the program implementation. In N2, the most at-risk age group was 81-90 in male patients (Fig. 4). There was a sustained reduction of HAPI from the highest rate 1.88 % /per 1000 bed days to 0% / 1000 bed days. The absolute number of HAPI was dropped from 3 (June – August 2019) to 0 (September – November 2019) (Fig. 3). There was no HAPI (Table 2). The overall compliance rate on PI prevention was increased from 77.17% to 96% (Fig. 5). 100% of frontline newly graduated staff agreed “REMIND” program enhanced their knowledge and confidence in prevention of PI.(Fig.6)
