Authors (including presenting author) :
Lee YF(1), Mark YF(1), Hung YK S(1), Leung FY C(1)
Affiliation :
(1)Medical Unit, Queen Elizabeth Hospital
Introduction :
Pressure Injuries (PI) are common in patients admitted to medical wards, which cause a significant burden on health care resources and costs. Elderly patients are particularly prone to develop pressure injury due to factors such as being bedbound, poor mobility, poor nutrition, incontinence, and dry skin, etc. PI risk assessment requires adequate knowledge of PI mechanism and stages. Unfortunately, health-care providers in general have suboptimal knowledge of & motivation for PI care and its prevention (1). Hence, applying the “Behavior Change Wheel” model, a framework for designing behavior change interventions, to change the health-care workers’ behavior towards PI is an evidence-based approach to bring better quality care (2). Behavior occurs as an interaction of capability, motivation and opportunity. Capability refers to an individual’s underlying psychological and physical abilities. Opportunity relates to both their social and physical environment and motivation relates to both their underlying automatic and reflective processes. The target behaviors include PI risk assessment, application of prophylactic dressing, and repositioning. The interventions include education, training, modeling, and feedback on the behavior. Instructions on how to achieve the target behavior and information on the health consequences are included in the PI care bundle.
References
1. Thorpe E. “Pressure Ulcer Prevention in Intensive Care”. Wound UK 2015; Vol 11, No 2: 112-115.
2. Lavallee J F, et al. “Prevention Pressure Injury in Nursing Homes: Developing a Care Bundle Using the Behaviour Change Wheel”. BMJ Open 2019; 9: e026639. doi:10.1136/bmjopen-2018-026639.
Objectives :
- To improve the awareness, knowledge and skills of the staff in order to provide quality prevention of pressure injury care to patients.
- To reduce the incidence of pressure injuries in Medical Department.
- To reinforce the caring behavior of 2nd tier wound nurses and Patient Care Assistants on pressure injury prevention care bundle.
Methodology :
- Educational Training workshop on PI Care Bundle for Patient Care Assistants in the Department of Medicine was conducted in Nov. 2020
- Educational Training workshop on PI Care Bundle for 2nd Tier Wound Nurse in Department of Medicine was conducted in April 2020
- Training workshops included theory inputs, demonstrations and participants’ return demonstrations.
- PI Care Bundle:
Application of skin protective dressing
Skin care
Positioning and repositioning
Applying pressure release devices
Encouraging patients to do exercise as prescribed by physiotherapists.
Monitoring of nutritional status to build up body energy. (consult Dietitian when needed)
- Pre- and Post-training questionnaires were collected
Result & Outcome :
- A total of 74 PCAs and 2nd Tier Wound nurses attended the training workshop
- Pre- and Post-training questionnaires showed significant improvement on the knowledge and skill applications on PI care bundle
- More understanding of the misconceptions and beliefs of PI prevention in the workshop for PCAs.
- Care bundles may be an effective tool to guide and improve care consistency and evidence-informed practice
- It was agreed that nutrition and hydration should be included in the care bundle after group discussion in the workshop
- The importance of skin assessment, repositioning techniques, continence care and shearing force were highlighted in the workshop for PCAs.
- The application of Prophylactic Dressing Materials to prevent and management of PI were highlighted in the workshop for 2nd Tier wound nurses.
- To improve pressure injury prevention in the Medical Department, we identified that the BCT components of the interventions should include information about the health consequences and how to implement the care bundle elements in practice. An interactive group session, together with printed materials and PowerPoint illustrations could increase the uptake of knowledge and familiarizes staff with the processes involved.
