Nursing Education Program for Hospital-Acquired Pressure Injury Prevention in Adult Acute Care Setting: A Quality Improvement Project

Medical Device-Related Pressure Injury Care and Prevention Training Program (DevICeU): Effects on intensive care nurses' knowledge, prevention performance and point prevalence

OBJECTIVE

To determine the effect of the training given to intensive care unit (ICU) nurses to prevent medical device-related pressure injuries (MDRPIs) on nurses' knowledge levels, their prevention performance, and the point prevalence (PP) of MDRPIs.

RESEARCH METHODOLOGY/DESIGN

A pre-post test intervention study without a control group.

SETTING

The study was conducted between May and July 2023 with ICU nurses in three phases: pre-training phase (E0) (104 nurses, 116 patients), training implementation phase (E) and post-training phase (E1) (89 nurses, 120 patients).

MAIN OUTCOME MEASURES

The data were collected by using the Patient (E0, E1) and Nurse (E0) Characteristic Forms, MDRPI Follow-up and Prevalence Form (E0, E1), D.E.V.I.C.E Performance Observation Checklist (E0, E1), MDRPI Knowledge Assessment Questionnaire (E0, E1), Braden Pressure Ulcer Risk Assessment Scale (E0, E1), Pressure Injury Grading Form (E0, E1), and Feedback Form about the Training Process (E).

RESULTS

The mean MDRPI knowledge score of the nurses increased significantly from E0 to E1 (13.23 ± 1.43 vs. 20.02 ± 1.30, p = 0.001), with the highest improvement in the staging and prevention themes. Nurses' MDRPI prevention performance increased significantly from E0 to E1 (2.15 ± 1.01 vs. 11.17 ± 1.65, p = 0.001). There was a significant difference between the PP rate at E0 (61.2 %) and E1 (27.5 %) (p = 0.001).

CONCLUSION

The study indicated that the training on MDRPIs given to ICU nurses increased their knowledge and prevention performance and decreased the prevalence of MDRPIs. However, further studies with a larger sample size are needed to confirm these findings.

IMPLICATIONS FOR CLINICAL PRACTICE

Since MDRPIs have more complex staging and prevention practices than conventional PIs, they require the adoption of a training approach that includes visual materials and practical methods in addition to theoretical knowledge. Accurate definitions of medical device dimensions and fixation, skin assessment, and prevention practices will lead to the desired outcome of reducing MDRPIs in ICUs.

A Peer-to-Peer Approach to Increasing Staff Competency and Engagement in Wound and Ostomy Care: A Quality Improvement Project

PURPOSE

The purpose of this quality improvement (QI) project was to provide an innovative, participatory approach to the education of staff nurses and nursing support personnel to improve skills and competencies in wound and ostomy care while enhancing staff engagement and empowerment.

PARTICIPANTS AND SETTING

Project planning occurred between January and October 2020 and implementation began in November 2020. The project was implemented in 1 intensive care unit and 6 adult medical-surgical units of a 288-bed community hospital in the northeastern United States (Bronxville, New York). Participants included RNs and nursing support staff working in intensive care and medical-surgical units. A postimplementation survey was conducted in May 2021.

APPROACH

The Plan-Do-Study-Act (PDSA) model was used as a framework for this QI intervention. A peer-to-peer approach to staff education addressing different learning styles was used to improve knowledge and competencies of staff nurses pertaining to wound and ostomy care.

OUTCOMES

There were 72 participants; 68% (n = 49) exhibited knowledge retention 5 months after initial participation; 85% (n = 61) reported a high level of engagement; and 97.5% (n = 70) reported a high level of satisfaction 5 months after project implementation.

IMPLICATIONS FOR PRACTICE

An emerging need exists for educational innovation regarding wound and ostomy care to improve quality of care, nursing care outcomes, and staff engagement. Through a peer-to-peer approach to wound and ostomy care education, enhanced clinical knowledge and competencies can result in improved patient safety and increase care outcomes.

Feasibility, acceptability, and usability of implementing a medical device-related pressure injury algorithm for critically ill patients using non-invasive ventilation

OBJECTIVES

Describe the feasibility, acceptability, and usability of implementing a nurse-led intervention to prevent medical device-related pressure injury in critical care patients using non-invasive ventilation during hospitalization.

STUDY DESIGN

A quality improvement project, using a descriptive single-arm study design with convenience sampling.

SETTING AND PARTICIPANTS

This study was conducted at a Midwestern medical center with 640 beds (two hospital campuses). After an educational session, the nurse-led algorithm for non-invasive ventilation medical device-related pressure injury prevention was implemented in two critical care nursing units (cardiac medical progressive care and neurotrauma intensive care unit). Nursing staff were full or part-time critical care nurses.

MAIN OUTCOME MEASURES

Feasibility, acceptability, and usability of the non-invasive ventilation medical device-related pressure injury algorithm were measured (bedside rounding and pre/post System Usability Scale).

RESULTS

Thirty-five nurses (52.2 %) completed a pre-educational survey; 8 (11.2 %) completed a post-survey. The total mean pre-survey score was 70.7 (SD ± 13.6) and the post-survey mean score was 71.3(SD ± 19.6). There was a statistically significant increase in the post-survey mean score {Χ2 (1, N = 43) = 43.5, p <.05}, however, the 0.06 increase was not clinically meaningful. Bedside rounding interviews (n = 22) indicated 82 % (n = 18) of the nurses used the algorithm. The SUS tool mean score was 83.3 (10.73) pre-implementation (n = 21); and 85.63 (8.26) post-implementation (n = 5), indicating clinical usability of the algorithm pre- and post-implementation.

CONCLUSION

The feasibility, acceptability, and usability of implementing a medical device-related pressure injury algorithm for critically ill patients using non-invasive ventilation were demonstrated during this study. More nursing research is needed to develop scalable interdisciplinary clinical algorithms to reduce medical device-related pressure injuries in patients using non-invasive ventilation.

IMPLICATIONS FOR CLINICAL PRACTICE

This study focused on the bedside usability of the algorithm in a clinical setting. Implementing this nursing-developed algorithm created an interdisciplinary framework in which nursing assessment may guide clinical care.

Knowledge and Visual Differentiation Ability of the Pressure Injury Classification System and Incontinence-Associated Dermatitis among Hospital Nurses: A Descriptive Study

This study investigated clinical nurses' knowledge and visual differentiation ability of the pressure injury classification system (PICS) and incontinence-associated dermatitis (IAD), additionally analyzing possible influencing factors. A convenience sample of 248 nurses took the PICS and IAD knowledge test (KT) and completed the visual differentiation ability test (VDAT), consisting of 21 photographs with clinical information. The overall mean score for correct answers was 12.65 ± 2.90 points in PICS and IAD KT and 11.43 ± 4.57 points in VDAT. Incorrect responses were most common for statements related to stage II, III, IAD for PICS and IAD KT, and deep tissue pressure injury (DTPI), unstageable, and stage III for VDAT. Significant correlations were found between PICS and IAD KT and VDAT (r = 0.252, p < 0.001). Factors affecting scores for VDAT were the scores of PICS and IAD KT, debridement experience in nursing patients with PI, and the management frequency of PI and IAD. Results indicate that nurses have an overall understanding of PICS and IAD, but low visual differentiation ability regarding stage III, DTPI, and unstageable PI. Continuing education is needed to further improve knowledge and visual differentiation ability for PICS and IAD.

Improving the Use of Subscale-Specific Interventions of the Braden Scale Among Nurses

BACKGROUND

Pressure injuries (PIs) are costly to hospitals and have a negative impact on patient outcomes. Despite the use of validated tools that describe PI risk, such as the Braden Scale, the incidence of PIs remains high. Studies have shown that Braden Scale subscale scores should be considered when planning care; however, there is a discrepancy between understanding the importance of subscale-specific interventions and implementation. The goal of this study was to test the ability of an educational intervention tailored to specific interventions based on the subscales of the Braden Scale to improve knowledge among nurses.

METHOD

This study was a prospective, quasi-experimental, single-group design where nurses (n = 35) from a neurosurgery stepdown unit in a large teaching hospital completed a preintervention survey (T1), attended an educational presentation, and then completed an immediate postintervention survey (T2) and a 2-month postintervention survey (T3).

RESULTS

Data analysis compared presurvey scores with postsurvey scores. Nursing comprehension improved from the preintervention survey (T1, M = 5.57) to the postintervention surveys (T2, M = 6.34; T3, M = 6.42) (p = .031).

CONCLUSION

Nurses showed increased comprehension after the educational intervention from T1 to T3. [J Contin Educ Nurs. 2024;55(1):42-48.].

Driving Hospital-Acquired Pressure Injuries to Zero: A Quality Improvement Project

OBJECTIVE

To implement a collaborative, interdisciplinary team approach to reducing hospital-acquired pressure injuries (HAPIs) through nurse empowerment and engagement.

METHODS

This quality improvement project was conducted at a 288-bed community hospital. The Donabedian model was used to design this intervention. The authors used a collaborative, interdisciplinary team approach for pressure injury prevention and management, utilizing nurse empowerment and engagement as driving forces to reduce HAPI rates.

RESULTS

The incidence of HAPI decreased from a peak of 5.30% in April 2019 down to 0% from August 2019 to December 2020.

CONCLUSIONS

Pressure injuries are key quality indicators for patient safety and avoidance of patient harm. Through nurse empowerment and engagement, HAPIs were avoided, resulting in improved quality care outcomes and maintenance of a safe patient environment.

Reducing lower extremity hospital-acquired pressure injuries: a multidisciplinary clinical team approach

OBJECTIVE

Optimal methods of reducing incidence of hospital-acquired pressure injuries (HAPIs) remain to be determined. We assessed changes in yearly incidence of lower extremity HAPIs before and after an intervention aimed at reducing these wounds.

METHOD

In 2012, we implemented a three-pronged intervention to reduce the incidence of HAPIs. The intervention included: a multidisciplinary surgical team; enhanced nursing education; and improved quality data reporting. Yearly incidence of lower extremity HAPIs was tracked.

RESULTS

Pre-intervention, incidence of HAPIs was 0.746%, 0.751% and 0.742% in 2009, 2010 and 2011, respectively. Post-intervention, incidence of HAPIs was 0.002%, 0.051%, 0.038%, 0.000% and 0.006% in 2013, 2014, 2015, 2016 and 2017, respectively. Mean incidence of HAPIs was reduced from 0.746% before the intervention to 0.022% after the intervention (p<0.001).

CONCLUSION

An intervention by a multidisciplinary surgical team enhanced nursing education, and improved quality data reporting reduced the incidence of lower extremity HAPIs.

Dose health education on dementia prevention have more effects on community residents when a community physician/nurse leads it? A cross-sectional study

Background

Dementia is a growing public health concern worldwide. Community residents still have limited knowledge about dementia prevention, although many sources are accessible for individuals to acquire knowledge.

Methods

A questionnaire-based survey was conducted in five communities in Chongqing, China, between March 2021 and February 2022. Participants were divided into three groups according to the dementia-related education they received: physician/nurse-led, mass media, and no relevant education. Covariance analysis was performed to determine the differences among the three groups in knowledge, motivation, and lifestyle, with the covariate of MoCA scores (education-adjusted).

Results

Of the 221 participants, 18 (8.1%) received physician/nurse-led education, 101 (45.7%) received only mass media education, and 102 (46.2%) did not receive any relevant education regarding dementia prevention. Participants who only received mass media education had a higher level of education (t = 5.567, p = 0.004) and cognitive function (t = 13.978, p < 0.001). The analysis of covariance showed that compared with participants who received no relevant education, those who received physician/nurse-led education had higher levels of knowledge, perceived benefits, and better lifestyle, and those who received mass media education had lower perceived barriers; however, higher levels of cues to action, general health motivation, self-efficacy, and lifestyle (all p < 0.05).

Conclusion

The popularization of dementia-related education was not ideal for communities. Physician/nurse-led education plays a vital role in providing knowledge and promoting lifestyles for dementia prevention, but may not motivate community residents. Mass media education may help encourage residents and promote their lifestyles.

Prevention and management of hospital-acquired pressure injury among patients with lung disease in a hospital: a best practice implementation project

OBJECTIVES

The aim of this project was to promote evidence-based practice in the prevention and management of pressure injury in lung disease patients.

INTRODUCTION

Pressure injury is a crucial quality indicator for hospital care of patients. The pressure injury incidence threshold in the chest wards has been exceeding that of the general ward (0.128%), which may extend patients' hospital stay.

METHODS

Clinical audits were performed using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice (GRiP) audit and feedback tool. Twelve audit criteria representing best practice recommendations for preventing and managing pressure injury among lung disease patients were used. A baseline audit was performed to measure the degree of consistency between existing practice and best practice. This project used the GRiP analysis and multiple strategies to develop care protocols for pressure injury prevention and management. A follow-up audit was conducted to measure changes in clinical practice and pressure injury incidence.

RESULTS

Postimplementation audit compliance rates improved for the following criteria: skin assessment for identifying pressure injury indications (from 31 to 81%), identification of pressure injury risk score/category (from 19 to 88%), employment of nutritional assessment tools (from 8 to 93%), and provision of information regarding oral nutritional supplements (from 23 to 84%). Furthermore, patients learning the pressure injury care protocols (from 48 to 93%), the receipt of additional skin protection measures, and repositioning of vulnerable areas to relieve pressure increased to 100 and 93%, respectively. After project implementation, the monthly pressure injury incidence decreased markedly from 0.075 to 0.021%.

CONCLUSION

The success factors of this project are attributable to leadership, open communication, multiple learning-by-doing strategies, regular audits, and the promotion of patient and family engagement.

Impact of tailored training about pressure injuries on nurses' knowledge levels and pressure injury point prevalence: The case of Turkey

AIM

This study was conducted to determine the impact of tailored training provided to nurses for preventing pressure injuries (PIs) on nurses' knowledge levels and the PI point prevalence (PP).

MATERIALS AND METHODS

This interventional study was carried out in a university hospital with a bed capacity of 1114 in an urban center in Turkey. Ethics committee approval (28.06.2018/31) and institutional permission were obtained for the study, in addition to the nurses' written, informed consent. The study was completed in three stages. In the first stage an initial PP study was conducted in the clinics with the participation of the nurses and the members of the research team (n = 422 patients). In the second stage the knowledge levels of 194 nurses were measured before training was given on following-up and preventing PIs. The nurses then participated in the tailored training and their knowledge levels were re-measured afterwards. All the nurses were given individual advice related to the prevention of PIs for 30 days after they had completed the training. In the third stage a second PP study was conducted four months after the first PP study (n = 454 patients). The data were collected using the Pressure Injury Prevalence Form, the Braden Pressure Ulcer Risk Assessment Tool and the Knowledge Level Measurement Form. Descriptive values, the paired samples t-test, Pearson's chi-squared test and Fisher's Exact test were used to evaluate the data.

RESULTS

The nurses' pretest mean knowledge score was 55.36% ± 14.40 and their posttest mean score was 69.92% ± 9.73. The difference between these scores was statistically significant (p < 0.05). The study found no significant difference between the first PP ratio and the second PP ratio (p > 0.05), and the nurses were better able to evaluate skin and PIs after the training.

CONCLUSION

The study determined that the tailored training given to the nurses increased their knowledge; however, it had no impact on the PP after four months. It is recommended that any training programs using this model be continued and that PP studies of institutions be conducted annually.

Classification of Pressure Injury Stages and Skin Damage Photographs by RNs and Nursing Students in Spain: An Observational Comparison Study

PURPOSE

The purpose of this study was to evaluate and classify pressure injuries (PIs) and other skin lesions according to the judgment of hospital-based RNs and nursing students who recently trained in wound care using photographs and comparing findings to those of wound care experts.

DESIGN

Cross-sectional observational survey.

SUBJECT AND SETTING

RNs working at Manacor Hospital, Mallorca, Spain, and third-year nursing students from the University of the Balearic Islands. Data were collected in June 2017.

METHODS

The survey instrument was accompanied by a set of 24 photographs in 7 categories of skin lesions, such as PIs or moisture-associated skin damage, which the respondents were asked to classify. Descriptive analysis of the classifications was carried out, and levels of agreement using the chi-square test were compared with evaluations/classifications of a panel of experts.

RESULTS

In total, 314 surveys (199 RNs and 115 students) were included in the analyses. Findings showed a wide variability among participants with levels of agreement, with expert opinion ranging from 91.4% to 15.61%. The levels of agreement were substantially lower for unstageable PIs (47.92%), those caused by moisture (53.50%), and mixed etiology (38.37%) than for stages 1-4 PIs. Of note, 62.12% of RNs had not received PI training or continuing education during the previous 2 years. This lack of education was statistically significantly associated with the accuracy of the classification made by the RNs for some of the photographs evaluated such as moisture-associated skin damage.

CONCLUSIONS

We found discrepancies in the classification of PIs and other wounds/lesions among experts, RNs, and students. The regular provision of up-to-date information in training and continuing education programs is imperative to maintain nurses' abilities to identify and classify PIs and other skin-related damage.

Development of an Interdisciplinary Healthcare Team for Pressure Injury Management: A Quality Improvement Project

PURPOSE

The purpose of this quality improvement project was to create an interdisciplinary healthcare team for the management of patients with stage 3, stage 4, and unstageable pressure injuries (PIs), improve the communication among the interdisciplinary healthcare team, test the educational level of the nursing staff regarding PI management, and conduct quarterly PI prevalence surveys to decrease the rate of the hospital-acquired pressure injuries (HAPIs).

PARTICIPANTS AND SETTING

Patients with stage 3, stage 4, and unstageable PIs in medical adult inpatient units of a private tertiary hospital located in the eastern province of Saudi Arabia were included in the study.

APPROACH

During the project period (February 21, 2017, to May 23, 2017), a healthcare team was formed consisting of a hospitalist, a plastic surgeon, a case manager, a dietitian, a physiotherapist, and wound and home health nurses. The team communication and staff adherence to the care plan were measured through an audit tool. Nurses' educational level was measured by pre- and posttest assessments. In addition, a quarterly PI survey day was conducted twice to monitor the occurrence of HAPIs and to reevaluate nursing staff knowledge of management of HAPIs.

OUTCOMES

Results showed improvement in communication within the interdisciplinary team regarding care of patients with HAPIs, with 100% staff adherence to the plan of care. In addition, unit-based educational sessions conducted to measure staff knowledge showed a statistically significant increase (P < .000). Although small, the HAPI rate decreased from 5.9% to 5% during this short 3-month study.