Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Chong HM(1), Chan CH(2), Li YS(3), Wong MY(4), Lam MS(5), Leung AYL(5)
Affiliation :
(1)Department of Surgery, Tuen Mun Hospital, (2)Department of Medicine and Geriatrics, Tuen Mun Hospital, (3)Wound Team, Pok Oi Hospital, (4)Department of Medicine and Geriatrics, Pok Oi Hospital, (5)Nursing Services Division, Pok Oi Hospital/Tin Shui Wai Hospital
Introduction :
Structured pressure injury (PI) prevention and management program is essential to prevent pressure injury and maintain quality of care in hospital setting. This includes evidence-based practice, multi-disciplinary involvement, comprehensive staff training, sufficient staff engagement, accurate documentation and reporting, etc. Despite the fact that NTWC has PI prevention and management guideline, reinforcement is necessary to ensure quality of care. The incidence rate of PI was found relatively high in some areas, apart from early identification, proper positioning and application of appropriate devices are paramount.
Objectives :
To enhance quality of care in relation to pressure injury prevention and management in Pok Oi Hospital (POH) and Tin Shui Wai Hospital (TSWH). To increase nurse and supporting staff’s knowledge and skills in pressure injury prevention and management. To augment frontline staff understanding to cluster PI Prevention and Management Guideline.
Methodology :
After a panel discussion with managers and clinical expertise, a 5-month educational programme was conducted at in-patient care settings POH and TSWH, using a multi-faceted approach. Four aspects of clinical practices were identified of which enhancement is required. Agreement was sought on purposive sampling from GM(N). A Pre-programme clinical study on nurses and supporting staff compliance to NTWC PI Prevention and Management Guideline was done to identify the gaps. Various educational activities about PI and wound management included seminar, lectures and hands-on training were delivered to frontline staff. Post-programme clinical study was carried out again to obtain related data for outcome comparison.
Result & Outcome :
The pre-programme and post-programme clinical study was done in September 2022 and January 2023 respectively in six wards of POH and TSWH. Totally one session of seminar, four sessions of lecture and two sessions of hands-on training were delivered to frontline nurses and supporting staff. The post-programme clinical study showed increase in compliance rate of cluster PI Prevention and Management Guideline. 17 checking items obtained from pre-programme and post-programme clinical study were categorized into four aspects and thematically analysed. Preventive measure implementation aspect included skin care, continence care and repositioning of patient scored averagely from pre-programme 68.9% to post-programme 96.6%. Multidisciplinary collaboration aspect included dietetic, physiotherapy and occupational therapy referral scored increasing from 53.5% to 97.8% on average. Wound management aspect involved classification of PI staging and wound dressing selection scored from 71.5% to 95.0% on average. Documentation and reporting aspect involved Norton Scale documentation, wound documentation and newly developed pressure injury reporting scored averagely from 75.3% to 99.3%. The results reflected the educational programme was effective in enhancing the quality of care in relation to PI prevention and management.
