Implementation of strategies to reduce and manage hospital-acquired pressure ulcers: a qualitative improvement programme.

Abstract

Objective: To describe a quality improvement project based on the 'Standards for Quality Improvement Reporting Excellence' (SQUIRE) guidelines, to implement care bundles for pressure ulcer (PU) prevention and management.

Method: The study was conduct in the medical, surgical and intensive care departments of six hospitals in northern Italy, between 2002 and 2020. The data collection was carried out by the unit's nurses and nurse managers. Implementation strategies included the dissemination of the PUs standard of care, the engagement of the unit nurses' mangers, the definition and the adoption of a clinical tool for PU risk assessment, the decision algorithm for the Braden score range and the class of air surface, the definition of PUs being monitored and the auditing system.

Results: The development of a quality improvement programme allowed the authors to invest in a structured plan of organisational interventions, which impacted different areas such as leadership, staffing, information technology, performance and improvement. There was no significant change in the prevalence of PUs, which remained at around 11%, but the improvement program allowed for standardisation of PU risk assessment and the supply of air mattresses in the company. Therefore, an evidence-based PU prevention and management bundle, drafter by a multidisciplinary team, was implemented at the six hospitals.

Conclusion: Despite PU quality improvement programmes promoting healthcare professionals' adherence to evidence-based practice, demonstrating a measurable reduction in PU rates can be challenging in real-world settings. However, standardising clinical practice can generate reliable data to support targeted investments in nursing care and help establish an audit framework for evaluating clinical and organisational outcomes.

Declaration of interest: The authors have no conflict of interest to declare.