Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Lee YF(1), Leung FYC(1), Fong WC(1), Chan LTA(1&2), Lam WM(2), Leung KH(1), Tsang CH(1)
Affiliation :
(1) Department of Medicine, Queen Elizabeth Hospital, (2)Geriatric Day Hospital, Queen Elizabeth Hospital
Introduction :
Prevention of hospital acquired pressure injuries(PI) remians a significant challenge to physicians and nurses in acute medical wards. The self-adherent, multilayer prophylactic foam dressing are used in addition to standard care protocols for PI prevention. However, a systematic review examining the use of prophylactic dressings in local acute medical wards is lacking. The Department of Medicine, with the generous backing of our donors, initiated the Prevention of Pressure Injury (PIP) Program to evaluate the clinical efficacy of the prophylactic foam dressing.
Objectives :
1. To decrease pressure injury(PI) rate in medical wards
2. To identify patients with high risk of PI and to provide appropriate nursing interventions to these patients
Methodology :
It was a prospective, consecutive study that evaluated the effectiveness of prophylactic dressings and explored the factors related to PI development. The demographic data, clinical symptoms and personal characteristics related to PI would be obtained in the questionnaire and analyzed. This study was conducted in 20 acute medical wards in Queen Elizabeth Hospital. The project team provided training to staff in each ward, which included an overview of the study (recruitment, monitoring, and data collection) and instructions in the application and removal of the dressings. In addition to applying prophylactic dressings to the recruited patients, daily inspection, skin care, positioning and repositioning, preventive pressure device will also be provided. The primary end point of recruited subjects is the development of stage 1 or above PI.
Result & Outcome :
The primary outcome measure was the incidence of PI developed in the recruited patient during the study period. In the course of the program (Table 1), 2.9% of patients developed pressure injuries prior to discharge or transfer. While the study lacked a control group for direct comparison, this rate is commensurate with incidence rates observed in parallel trials (see Table 2).
The independent-samples t-test was used to determine whether there was a statistically significant difference between the means in two groups. An analysis of patient length of stay (LOS) revealed a significant difference between patients who developed pressure injuries and those who did not. The average LOS for patients who developed pressure injuries was 14.52 ± 9.2 days, whereas it was 7.21 ± 9.23 days for those without any pressure injuries (P = 0.000). The average LOS for all patients in the study was 7.42 days. The study also noted 46 extreme cases where the LOS exceeded 21 days, with the maximum LOS reaching 42 days. There was no major difference in the Norton score of the patients. (See Table 4)
The study also analyzed the comorbidity distribution among the patients. It was observed that 16.5% of patients had dual major diagnoses, while a smaller percentage (1.2%) had three or more diagnoses (Table 5).
Regarding the admission diagnosis of the patient, the most common diagnoses are Pneumonia, Stroke, Sepsis and Chest Infection (Table 6).
Conclusion: In conclusion, this study provided valuable insights into the performance of prophylactic foam dressing as a preventative measure against pressure injuries. However, all participants in the study had prophylactic dressing, and no case-control group was used for comparison. Further comparative studies are recommended to establish a more definitive understanding of its effectiveness.
