Authors (including presenting author) :
Chan SKA(1),Lo WC(1),Choy YM(1),Ho HY(1),Sin ML(1),Pi SS(1),Tam KFS(2),Poon YYM(3),Tsui SKA(3),Chan YPB(4),Wong YLR(5),Leung PFI(6),Tsang KK(7),Chong KWS(8)
Affiliation :
(1)Nursing Department, Hong Kong Buddhist Department,(2)Department of Medicine,Hong Kong Buddhist Hospital,(3)Phyiotherapy Department,Hong Kong Buddhist Hospital,(4)Occuaptional Therapy Department,Hong Kong Buddhist Department,(5)Quality and Safety Department,Hong Kong Buddhist Hospital,(6)Dietetics Department,Queen Elizabeth Hospital(7)Department of Orthopaedics & Traumatology,Queen Elizabeth Hospital,(8)Occupational Therapy Department,TWGHs Wong Tai Sin Hospital
Introduction :
Pressure injury incident not only induced great burden on healthcare expenditure but also caused a great suffer to patient. The healthcare expenditure on pressure injury was huge including dressing material, manpower and extra bed days. According to the Nursing Quality Annual Report of Hospital Authority (HA), the average hospital acquired pressure injury (HAPI) rate of Hong Kong Buddhist Hospital (HKBH) in 2016 was 1.125%. In bench marking with 0.47% overall HAPI rate in same Group 2 hospitals, there was a great disparity. As such, a care bundle on PI prevention was used to address such unsatisfactory condition.
Objectives :
To enhance quality and safe patient care; to empower healthcare staff and patient/carer in prevention of PI and to avoid physical and psychological suffer in patients due to PI.
Methodology :
The care bundle was implemented in April 2017. Multidisciplinary approach was adopted to provide patient-center care in PI prevention. Monthly client education talk was held to empower the client’s knowledge and skill in PI prevention. Regular training for nurses and supporting staff were conducted to strengthen their evidence-based practice. Enhancement of pressure relieving devices, same direction turning and heel-free program were promoted to relieve pressure over the bony prominence areas of at-risk patients. Regular physiotherapy training program was tailor-made to the patients with pressure relieving exercise such as back mobilization, bridging and walking, as well as bed mobility and transfer training. Monthly meeting of PI link nurses was held to analyse the monthly HAPI rate and the audit result on proper usage of PI prevention devices. The skin condition of at-risk patient was maintained healthy by application of barrier cream over the sacral region of patient. Quit diaper program and phototherapy were used to manage the microclimate of patient's skin. Weekly malnutrition screening was conducted and dietitian would be referred if indicated.
Result & Outcome :
The HAPI rate dropped from 1.125% in 2016 to 0.708% in 2017 and to 0.313% in 2018. Comparing 2016 with 2017, there was 53.5% drop of HAPI. Comparing 2016 with 2018, there was 72.2% drop of HAPI. The overall score on client satisfactory survey on education talk was 4.78 out of 5. In conclusion, hospital-wide staff engagement and client empowerment were successfully attained throughout the journey of PI prevention in Hong Kong Buddhist Hospital.
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