Use of a risk‐based intervention bundle to prescribe and implement interventions to prevent pressure injury: An observational study

Abstract

AbstractAimTo explore the relationship between the prescription and implementation of pressure injury preventative interventions following risk assessment combined with a risk‐stratified intervention bundle.DesignSingle‐centre, cross‐sectional, observational, prospective.MethodsThe charts and bedsides of 341 adult inpatients were examined. Data collection included pressure injury risk level, prescribed preventative interventions and evidence of intervention implementation.ResultsMost patients (68.6%) were at risk of pressure injury, and most interventions were prescribed according to their risk level. However, evidence from direct observation and/or documentation indicated intervention implementation rates were relatively poor. Of nine interventions mandated for all patients, compliance with three patient‐/carer‐focused interventions was particularly poor, with evidence indicating they had been implemented for 3%–10% of patients. Also, nutritional screening‐related interventions were implemented poorly. Clinically indicated implementation of heel‐elevation devices and bariatric equipment was low for at‐risk patients, and the implementation of interventions for patients with existing pressure injuries was suboptimal. Significant proportions of several interventions that were observed as having been implemented were not documented as such.ConclusionWhile most interventions were prescribed according to patient risk level, the overall implementation of interventions was poor. However, the results may in part be due to failure to document interventions as opposed to omitting them.Implications for Patient CareDocumentation of interventions is crucial as it provides evidence of the care provided. An increased focus on documentation of pressure injury preventative interventions is required, with a clear distinction between prescription and implementation.ImpactThe results highlighted several deficiencies in care, particularly relating to evidence of implementation, patient involvement and nutritional screening. The results from this study will be used to inform and improve future pressure injury prevention practice within the study hospital and should be used to inform and benchmark pressure injury preventative practices in other hospitals.Reporting MethodThe study adheres to STROBE guidelines.Patient or Public ContributionNone.