Prevention of Hospital-Acquired Pressure Injuries

University Of Detroit Mercy

Course Number and Name

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Prevention of Hospital-Acquired Pressure Injuries

Background Information

Hospital-acquired pressure injuries, commonly referred to as bedsores or pressure ulcers, are localized lesions to the skin and underlying tissue brought on by sustained pressure applied to the skin. They frequently affect bedridden or immobile individuals, particularly in regions like the elbows, heels, sacrum, and hips, where bones are near the skin. With almost 2.5 million Americans acquiring pressure ulcers annually, the national incidence of HAPIs is concerning and underscores the pervasiveness of this problem in acute care settings (Lfache & Dzioba, 2022; Bansal et al., 2005). At the local level, HAPIs account for approximately 20% of hospital-acquired conditions at our healthcare facility, Saint Luke's (2024); therefore, focused interventions are required to address this increasing issue. Over the last ten years, researchers at St. Luke's Hospital have tracked the rate of pressure injuries per patient volume, and they found that it fluctuated between 0.04 and 0.2 (St. Luke's, 2023; Leapfrog, n.d.). Compared to the previous era (2014-2020), rates have decreased in recent years (2021-2023). This might indicate that the hospital is improving its preventative measures or patient care methods

The financial effects of HAPIs go beyond the care of a single patient to include the more extensive healthcare system since treatment and administration come at a significant cost. Based on 2.5 million recorded instances, Padula and Delarmente (2019) estimate that the average price of HAPI could surpass $ 10,708 per patient, or about $26.8 billion, in the US each year. These expenditures include wound care product prices, specialty therapies, prolonged hospital stays, and extra staff needed for patient care. Additionally, HAPIs cause more extended hospital stays and more significant healthcare expenditures, which reduce the effect of pressure injuries on healthcare resources and patient outcomes. For example, sacral decubitus ulcers are more common in older people, and patients over 70 account for two-thirds of ulcer cases. According to Zaidi and Sharma (2024), 83% of hospitalized patients experienced ulcer development after five days of admission. These findings highlight the necessity of effective preventative methods and thorough assessment techniques.

Furthermore, HAPIs have a significant effect on patient mortality and morbidity rates, which can result in problems such as tissue necrosis, sepsis, and infections. The time to onset of pressure injury varies from patient to patient and from treatment plan to care routine. Some ulcers can develop quickly if preventive measures are not taken right away. According to Aghazadeh et al. (2020), pressure injuries were more common among patients receiving acute care (13.6%) than those in long-term care (42.1%) (Coyer et al., 2017). To lower the current rates of HAPIs and enhance the quality of patient care, healthcare facilities must prioritize evidence-based interventions, routine skin assessments, pressure-relieving devices, turning and repositioning protocols, staff education, and continuous outcome monitoring. 

Input on the problem

Patients, families, nurses, nurse managers, CNSs, and doctors participated in the research. Surveys and focus groups examined participants' PI interactions, educational materials, and communication issues. Stakeholder feedback helped St. Luke's Hospital prevent pressure injuries (PIs). Patient and family feedback on PI education was mixed; even though they got some information, some desired simpler, more accessible tools. However, nursing personnel stressed the need for additional resources to handle frequent PI situations. Nurses also underlined the importance of staff, patient, and family prevention communication. Nurse managers and CNSs praised PI policies, suggested improvements, and stressed constant tactic evaluation. Physician participation varied; some wanted more nurse collaboration, while others deliberately prevented PI. However, all doctors agreed that patient education was essential to avoiding PIs. 

Pressure injury prevention and management

According to National Pressure Injury Advisory Panel (NPIAP), European Pressure Ulcer Advisory Panel (EPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA) present three standards of care for preventing pressure injuries. They include;

 Risk assessment and risk factors- Risk assessment and risk factors must focus on identification of individuals with risks of developing pressure injuries (Pott et al., 2023). 

Skin and Tissue Assessment- Skin and tissue assessments should be performed on admission and regularly thereafter to monitor for changes in skin integrity, including erythema, blanchable or non-blanchable erythema, skin temperature, and tissue consistency (Pott et al., 2023).

Preventive Skin Care- Implement preventive measures to maintain skin integrity and reduce the risk of pressure injury development (Pott et al., 2023).

Flow diagram for current processes

To better understand the existing procedures for patient education on pressure injuries for Unit 5KLM, it is helpful to draw a flow diagram depicting the individual phases that make up this process. Nursing staff, patients, family members, nurse educators, and maybe even doctors or wound care experts are all considered stakeholders in this process. Improving communication lines between stakeholders, establishing uniform education procedures, educating nursing staff continually, using multimedia tools for patient education, and ensuring consistent documentation are all possible areas for improvement. This flow diagram may identify inefficiencies and brainstorm ideas visually to improve the patient education process in Unit 5KLM about pressure injuries

Critique of Current Problem

Patients are given inconsistent and variable-quality information due to the lack of defined pressure injury prevention education standards. Staff members might provide patients with incorrect or partial information if they are not given clear instructions, which could affect patients' ability to understand and follow preventative actions. Again, inconsistencies in the delivery of instruction on pressure injury prevention result from staff members' varied degrees of training. Some staff members may lack up-to-date knowledge or skills, which might cause gaps in patient education and raise the risk of pressure injuries. Furthermore, patients may get contradictory or erroneous information on preventing pressure injuries because of the absence of defined standards and inconsistent staff training.

Patients may not be actively engaged or have the best grasp of pressure injury prevention measures using the present instructional materials. Improvements like interactive technology and multimedia materials can increase patient engagement and understanding, improving adherence to preventative interventions. Efficient patient education requires meticulous documentation of follow-up exams and reinforcing acquired knowledge. Patients are more likely to sustain pressure injuries if they do not receive sufficient follow-up and reinforcement after implementing critical preventative measures. Additionally, all healthcare providers engaged in patient education should have the same knowledge and abilities, which may be achieved by standardizing staff training programs. This improves patient outcomes about pressure injury prevention, ensures that information is delivered consistently, and decreases the likelihood of misinterpretation. It all comes down to creating thorough lesson plans that cater to different reading levels and learning styles. Culturally relevant, brief, and easy-to-understand materials can help patients actively avoid pressure injuries.

Literature review

The research on pressure injuries emphasizes the issue's complexity and the need for patient education to prevent these injuries. According to Moore and Patton (2019), the best way to reduce the occurrence and severity of pressure injuries is to do risk assessments, discover them early, and intervene promptly. Repositioning regularly, using pressure-relieving devices, assessing and caring for the skin, providing nutritional support, and teaching patients and caregivers how to avoid it correctly are all part of this. Awareness of risk factors, instruction in preventative actions (such as frequent repositioning and skin examination), and encouraging active self-care are common goals of patient education programs (Team et al., 2019). Standardized teaching programs and comprehensive skin evaluation procedures are two examples of evidence-based interventions that have demonstrated promise in reducing the occurrence of pressure injuries in various healthcare settings (Lyder & Ayello, 2008). Initiatives that have been successful in comparable settings highlight the need for multidisciplinary teamwork, continuous staff training, and technology to improve patient education and bolster preventative measures (Buljac‐Samardžić et al., 2020). Unit 5KLM's improvement project can use these results to inform the creation of evidence-based practices uniquely suited to the unit's requirements and difficulties.

Learning objectives

After the patient education on PI prevention, the learner will be able to;

1. State what is pressure injuries.
2. State 2 ways to prevent getting pressure injuries.
3. Explain the early signs of pressure injuries.
4. Explain what to do if you suspect to have pressure injuries.
5. List two actions they can take during their hospital stay to prevent pressure injuries.

Brochure

Principles of health literacy

The healthcare brochure was meticulously designed with the target population's accessibility and efficacy in mind, according to health literacy principles such as cultural sensitivity, straightforward communication, and plain language. The material was provided clearly and quickly, avoiding complex medical terminology. Technical concepts were clarified using simple, explicit language, and jargon was kept to a minimum to help readers better understand the material. The brochure was arranged and structured to make it easy to navigate, with clear labels for each part. Bold writing and bullet points highlighted essential topics and presented the information logically. Visual aids like diagrams and pictures were included to augment the textual data and improve comprehension. The intended audience's language variety and cultural preferences were considered. With photos and examples that showcase the community's variety, the brochure was made to be welcoming and respectful of many cultures. The booklet was made available in translated versions in languages spoken by the target audience to overcome linguistic obstacles.

Measuring learning objectives

At the end of the patient education, the patient will be able to;

1. Demonstrate the importance of preventing pressure injuries 
2. Describe potential consequences after contracting pressure injuries
3. Demonstrate understanding and importance of early identification of pressure injuries
4. Express confidence in their ability to participate in pressure injury prevention strategies within the care plans
5. Demonstrate that they can communicate concerns about pressure injuries to their healthcare practitioners. 

First Interaction

The first interaction with pressure injuries at Aurora St. Luke Medical Centre start by greeting and introduction making sure the patients feel comfortable. Here is a table presenting activity and time; 

During admission; the first hours of meeting, patients will be made comfortable by introducing ourselves and setting clear goals. We will share while gathering information about pressure injuries. Our expectations upon completion of these interactions will be set clear. They include; demonstrating the importance of preventing pressure injuries, describing potential consequences after contracting pressure injuries, demonstrating understanding and importance of early identification of pressure injuries, expressing confidence in their ability to participate in pressure injury prevention strategies within the care plans and demonstrated that they can communicate concerns about pressure injuries to their healthcare practitioners. Assessment and examination will include physical examination of pressure sours. 

Second Interaction

After the first interaction, the second interaction will be on the second day and the activities of the second interaction include; review of findings, discussion of treatment plan, education and counseling, addressing questions and concerns and setting goals. Here is a table that presents the activities and time.

In the second phase of interactions, we will review findings from the previous interactions and discuss personalize treatment plan. Patients will receive personalized preventive care to cater for patient’s unique risk profile such that they know how to care for their pressure injuries during treatment. While devising risk assessment plans, patients will interact with educational materials and in our case brochures to help them know the concept of pressure injuries. For patients to understand, we will identify the topic, creatively present focus and key points. Include cases for examples and clear instructions. During the health literacy sessions, we will encourage engagement and follow-up. The presentation will start from explaining simple to complex concepts associated with pressure injuries. At the end, we will address questions and concerns and set clear goals. 

Third Interaction 

During this third interaction, we will encourage follow-up and monitoring, reinforcement of education, support and encouragement, planning for the future and scheduling follow-up with the institution. Here is an activity table and time scheduling of the third interaction;

This stage is more of following on the progress of patients of the last two interactions including monitoring of the symptoms, treatment plans and any new developments. While monitoring, we will reinforce education on pressure injuries. In great lengths we will discuss preventive strategies for future promotion of overall health and wellness. At the very end we will schedule follow-up appointments for further interactions on the issue of pressure injuries. 

Description of how Effective the Pilot was for patients 

Evaluation of the program involves whether intended goals were met. If the outcome was positive and prevention of pressure injuries was met. Patients demonstrated a coordinated multidisciplinary approach in preventing pressure injuries demonstrating that they goals were met. Patients gave feedback on the relevance of the information they received and how it impacted their lives. Participants made progressive changes in how they were handling planned care, especially on the treatment plans, lifestyle modifications and utilization of resources. We addressed arising logical, communication and cultural issues, compared expectations and long-term goals. 

Improvement of Brochure 

Improvement on the brochure was done on clarity, comprehensiveness and relevance of information. Visual appeal of the brochure especially on photos presented and layout was also improvement. Considering the demographics of our population, we reviewed language, tone and interactive elements such as interactive quizzes. Strategies to improve participation of all participants must be considered along side staff training. The brochure included photo presentation of cases with pressure injuries and elaborate explanations of how to prevent pressure injuries. A digital version of the brochure was created and has been included in the presentation. 

Revisions and implementations 

To assess collective progress, personalized revision and implementations needs to be made because each patient present unique risk profile hence unique preventive approaches will be employed. Aurora St. Luke Medical Centre in considering this will put in place a rebuts system merited in ongoing assessment and monitoring. Therefore, care plans changed from patient to patient because of the unique sets of risks each patient exhibited. 

Fourth Interaction 

Within our fourth interactions, we will audit adherence to preventive measures such as skin care routines, plans and support. Our expectations were to evaluate the quality measures patients are taking towards pressure injury prevention. Other expectations were to measure the quality of identifying areas that may require staff training and specific quality improvement programs. Expected occurrence in the program was to reduce healthcare costs, length of stay and patient satisfaction. Unexpected occurrences are the reduced costs and value-based outcomes.   

Description of a meeting about the brochure within the organization

A meeting was conveyed between patients, health practitioners and the leader across the organization. The meeting started with an introduction by the project lead on the brochure topic; pressure injuries. We provided an overview of our objectives, significance of the program initiative. The brochure was presented, highlighting the contents, the impacts of presentation and their impact patient education. Within the meeting we encouraged role-play scenarios to illustrate practical applications. The environment fostered collaborative exchange between leaders, health practitioners and leaders. By the end of the meeting, there was a consensus among attendees regarding the value of the brochure and the patient education process, with plans in place for its implementation and dissemination throughout the organization.

Sustainability Plan 

Our sustainability plan ensuring that patient education on pressure injuries including brochure and teaching processes is long term, we will implement training and support to staff nurses on presentations, effective use of brochure and patient education strategies. we would also implement on how one can integrate procedures and protocols into workflows. We would also establish robust documentation procedures to monitor patient satisfaction, treatment plans and health outcomes. For sustainability, implementation of quality improvement initiatives and partnerships and collaboration would refine our understanding on brochure content, teaching processes and staff training.

References

Aghazadeh, A., Lotfi, M., Asgarpour, H., Khajehgoodari, M., & Nobakht, A. (2020). Frequency and risk factors of pressure injuries in clinical settings of affiliated to Tabriz University of Medical Sciences. Nursing Open, 8(2), 808–814. https://doi.org/10.1002/nop2.685

Bansal, C., Scott, R., Stewart, D. R., & Cockerell, C. J. (2005). Decubitus ulcers: A review of the literature. International Journal of Dermatology, 44(10), 805–810. https://doi.org/10.1111/j.1365-4632.2005.02636.x

Buljac‐Samardžić, M., Doekhie, K. D., & Van Wijngaarden, J. D. H. (2020). Interventions to improve team effectiveness within health care: a systematic review of the past decade. Human Resources for Health, 18(1). https://doi.org/10.1186/s12960-019-0411-3

Coyer, F., Miles, S., Gosley, S., Fulbrook, P., Sketcher‐Baker, K., Cook, J., & Whitmore, J. (2017). Pressure injury prevalence in intensive care versus non-intensive care patients: A state-wide comparison. Australian Critical Care, 30(5), 244–250. https://doi.org/10.1016/j.aucc.2016.12.003

Leapfrog. (n.d.). Hospital Details Table. https://www.hospitalsafetygrade.org/table-details/aurora-st-lukes-medical-center-of-aurora-health-care-metro

Lfache, N. a. V., & Dzioba, D. A. (2022, November 17). Why investing in hospital-acquired pressure injury prevention technology makes financial sense. HFMA. https://www.hfma.org/operations-management/care-process-redesign/why-investing-in-hospital-acquired-pressure-injury-prevention-te/

Lyder, C. H., & Ayello, E. A. (2008, April 1). Pressure ulcers: a patient safety issue. Patient Safety and Quality - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK2650/

Moore, Z., & Patton, D. (2019). Risk assessment tools for the prevention of pressure ulcers. The Cochrane Library, 2019(1). https://doi.org/10.1002/14651858.cd006471.pub4

Padula, W. V., & Delarmente, B. A. (2019). The national cost of hospital‐acquired pressure injuries in the United States. International Wound Journal, 16(3), 634–640. https://doi.org/10.1111/iwj.13071

  Pott, F. S., Meier, M. J., Stocco, J. G. D., Petz, F. de F. C., Roehrs, H., & Ziegelmann, P. K. (2023). Pressure injury prevention measures: overview of systematic reviews. Revista Da Escola de Enfermagem Da U S P, 57, e20230039–e20230039. https://doi.org/10.1590/1980-220X-REEUSP-2023-0039en 

Saint Luke's. (2024, January 1). Pressure injuries. Saint Luke's Health System. https://www.saintlukeskc.org/health-library/pressure-injuries-0

St. Luke's. (2023). Home. https://checkpoint.wha.org/TrendReport/TrendReport?measurementID=88&facilityID=087

Team, V., Bouguettaya, A., Richards, C., Turnour, L., Jones, A., Teede, H., & Weller, C. (2019). Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis. International Wound Journal, 17(2), 370–379. https://doi.org/10.1111/iwj.13281

Zaidi, S. R. H., & Sharma, S. (2024, January 3). Pressure ulcer. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK553107/