Multicomponent interventions to prevent and manage pressure injuries in hospital

Abstract

Pressure injuries are areas of localised damage to skin and underlying tissue, usually over bony prominences. They are associated with pain, prolonged hospitalisation, poor quality of life, increased morbidity and risk of mortality. An audit of pressure injury risk assessment forms on medical wards identified poor compliance with pressure injury prevention and increased prevalence of pressure injuries among patients, from 1.6% in 2011 to 20.4% in 2015. A study exploring nurses knowledge and practices on wound assessment identified more than half of the participants had limited knowledge, confirmed in an audit of nursing documentation of wound progress. Interventions to reduce risk of pressure injuries and improve management of pressure injuries require a comprehensive and multidisciplinary approach. The framework used to achieve this are outlined. Multicomponent interventions involving development of care practices using a team approach include standardising pressure injury documentation and continuous education. The TaPIE (TAilored Pressure Injury Education) intervention for nurses and caregivers on reducing pressure injury is currently being undertaken. Nurse-led wound management utilising the TIME approach and monthly wound case conference improved ward-based management of pressure injuries. Community follow-up by home based nurses of complex wounds is facilitated by tele-assessment through electronic digital images shared with clinicians if there are uncertainties in management.​