The incidence of pressure injuries is a quality indicator, it reflects the quality of clinical nursing. Pressure injuries may yield pain and infection, reduce the quality of life for inpatients, increase the length of stays and medical costs. The incidence of pressure injuries in this general ward of medical center showed an upward trend year by year from 2015 to the first season in 2018. The incidence of pressure injuries in the first season in 2018 was 0.129%, it exceeded the threshold 0.128%. The implementation rate of pressure injury prevention was only 5.9% among 17 high-risk inpatients (Braden scaleā¦18) during the period from April 1 to April 30, 2018.
Purpose:
The purpose of this project was to improve implementation rate of pressure injury prevention, and reduce the incidence of pressure injuries in this general ward.
Methods:
The project team of quality control circle conducted literature review, direct observation, brainstorm, investigation, interview, and examination of knowledge and skill. After comprehensive analysis, the possible causes of problems were identified as follows: lack of knowledge, misunderstanding of duties to change position, negligence of changing position, incomplete hand-off about risk factors and precautions, inadequate auxiliary turning tools, and the inconvenient process to get prophylactic dressings. According to the Plato chart, on the basis of 80/20 rules, the main 80% causes from most to least was lack of knowledge, negligence of changing position, incomplete hand-off about risk factors and precautions, and misunderstanding of duties to change position. The project team proposed all possible solution strategies to the main causes. The decision matrix analysis was used to select these appropriate strategies via appraising the benefit, feasibility and economy. The adopted solution strategies were carried out in August, 2018, included providing in-service education with experience curriculum, hosting a rewards program competition, and establishing the risk factors - precautions checklist.
Results:
After implementation of the intervention, the accuracy rate of nurse staff's knowledge test increased from 62.5% to 83.5%, the accuracy rate of nurse staff's changing position skill increased from 50% to 78%. The implementation rate of pressure injury prevention was 84.2% and 83.8% among 38 and 37 high-risk inpatients in September and October, 2018. The incidence of pressure injuries was both 0% in September and October, 2018. It reached the designated goal (<0.128%), and indicated a significant improvement and continuous effect.
Conclusion:
This project could serve as a reference for clinical care units to improve the implementation of pressure injury prevention and reduce the incidence of pressure injuries. It will be helpful to promote the quality of clinical nursing care and improve the quality of life for inpatients.