Reducing hospital-acquired pressure injuries

Abstract

Hospital-acquired pressure injury is a common preventable condition. Our hospital is a 144-bed governmental hospital in the Kingdom of Saudi Arabia that was found to have a 7.5% prevalence of hospital-acquired pressure injury in 2016. The aim of the improvement project was to reduce the prevalence of pressure injuries in our hospital from 7.5% to below 4% by the end of 2017. Our strategy for improvement was based on the Institute for Healthcare Improvement Model for Improvement. The change strategy was based on implementing an evidence-based risk assessment tool and a bundled evidence-based pressure injury prevention (PIP) intervention termed PIP bundle. After implementing the change package, we observed a reduction in the prevalence of pressure injuries by 84% (RR 0.16;95% CI 0.07 to 0.3; p value <0.0001) over a period of 12 weeks, in addition to an improvement in the compliance of pressure injury risk assessment and PIP interventions. The use of an evidenced-based bundled approach to prevent hospital-acquired pressure injuries has resulted in a significant reduction in the rate of pressure injuries. Improvement results were sustainable. In addition, our outcome measure exhibited minimal variability.

Keywords: bed Sore; hospital; pressure ulcer; prevention.

Figure 1

Project PDSA cycle ramp. PDSA, Plan-Do-Study-Act.

Figure 2

P-chart of the prevalence of in-patient pressure injuries pre and post project.

Figure 3

Run chart for compliance with (A) pressure injury risk assessment, (B) patient turning, (C) use of pressure injury mattresses and (D) prophylactic dressing over a bony prominence.