Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Man YL(1), Lau FCA(1), Leung KH(1), Li YS(2)
Affiliation :
(1) Occupational Therapy Department, Pok Oi Hospital, NTWC (2) Wound team, NTWC
Introduction :
Pressure injuries (PI) pose a negative impact on patient’s rehabilitation by increasing patient morbidity and prolonging hospital stays. Timely and appropriate application of support surface is important for effective pressure redistribution, preventing further deterioration of wounds and promoting healing. Occupational therapists assess patient’s needs and recommend suitable pressure care devices to minimize risk of PI. Since management can vary in PI location, severity and patient’s body shape, Occupational Therapists may prescribe or customize different positioning aids to meet individual’s needs. However, the process is often time-consuming, lasting up to 8 days. Fair compliance and application of positioning devices in ward can lead to suboptimal results.
Objectives :
1. Improve the efficiency of prescribing, utilizing and monitoring pressure care devices
2. Empower knowledge and skill of ward PCA on proper positioning and application of pressure care devices
Methodology :
This on-going improvement project comprised of three areas: 1. Expanding the pool of pressure care devices for fast track prescription: Collaboration between Nursing Services Division and Occupational Therapy Department has been launched to purchase and equip pressure redistribution devices for in-patient use. Besides, Occupational Therapist have also pre-fabricated modular based devices with adjustable feature, which covered all common PI areas including sacral, back, ears and heels to cater individual’s needs. 2. Providing regular staff training for empowerment: Training workshops had been arranged collaboratively with wound nurse to enhance staff’s knowledge and skills. 3. Enhancing interprofessional communication: Standardized instruction sheets with photo guide were produced and provided to ward and caregivers for reference. Occupational therapists conduct regular reviews on device application.
Result & Outcome :
From 11/2022 to 10/2023, a total of 2336 referrals were made to Occupational Therapy through Pressure Injury Management Program, which was 105% increase compared with the same period in 2021/22. The ratio of referrals for PI management increased from 5.8% to 9% of total referrals. The fast-track program reduced 80% of average time cost in preparing for the pressure care device. In average, 54 special positioning devices could be prescribed to patient in 3 months, compared with only 10 tailor-made devices in the conventional way. Occupational therapist could timely prescribe most of the suitable device to patients within a day after assessment. Three training workshops were conducted for 60 PCAs and 23 link nurses in November 2022, May and July 2023. Post workshops evaluation showed a 26% improvement in knowledge test. Participants expressed that the workshops were useful and the average satisfaction score was 5.4 out of 6. From 2Q2019 to 1Q2020, the average PI rate was 0.25 per 1000 inpatient bed days in Pok Oi Hospital. After implementation of the project from 2Q2022 to 1Q2023, it decreased to 0.21. It was comparably favorable than the data of HA Group 1 (General Acute) Hospitals which was increased from 0.53 to 0.6 in the same period. Overall, the outcomes are inevitably win-win-win for the betterment of patient care, staff empowerment and the reduction of PI rate of hospital.
