Getting to the bottom of hospital-acquired pressure injuries in one local health district: Translating knowledge into practice

Abstract

Background Hospital-acquired pressure injuries are serious preventable skin injuries, which continue to occur despite the substantial investment in research, development of international guidelines and clinical interventions in prevention of hospital-acquired pressure injuries. This local health district of four hospitals and five community health centres experienced a substantial increase (by almost 60%) in hospital-acquired pressure injuries over a five-year period (2010 to 2014). Aim The overarching research aim of this study was to examine the increase in hospital-acquired pressure injurieswithin the local health district. Specifically, the study aimed to: Examine the reasons or causative factors for the increase in hospital-acquired pressure injuriesin the local health district Identify approaches to improve the implementation of prevention strategies in the local health district. Methodology Guided by thePromoting Action on Research Implementation in Health Services (PARiHS) framework,a series of qualitative and qualitative studies were conducted across four hospitals in this district. The focus of the research was to analyse in detail aspects of hospital-acquired pressure injuries and examine causative factors for the increased incidence in order to implement effective strategies. The findings of each sub study were used to guide innovative evidence-based approaches to hospital-acquired pressure injuryprevention. Strategies implemented included the formation of a district executive pressure injury taskforce, specialised subcommittees, skin integrity champions, educational campaigns, purchase of pressure injury relieving equipment and skin care products, and repeated quality measurements. Key stakeholder, patient and clinician engagement occurred at all levels with each aspect of the research. Data analyses were consistent with the approaches for the type of data collected. Findings Findings revealed complex multidimensional health system barriers at a patient, unit and organisational level. This included misdiagnosis and misclassification of hospital-acquired pressure injury in approximately 70% of cases, inadequate resources, and pressure relieving devices, skin care practice was not in line with current evidence and a statistically significant association with incontinence-associated dermatitis and hospital-acquired pressure injury. Nurses reported challenges in providing effective pressure injury prevention due to patient complexity and competing demands. However, nurses engaged and took ownership when they knew what was expected of them and when they understood the impact of their practice at a patient, unit and organisational level. As a result of this research, there was a substantial reduction in hospital-acquired pressure injuriesacross the district by 51.4% from 2014 (1.46 per 1000 bed days) to 2017 (0.71 per 1000 bed days); a reduction in the prevalence rate by 71.6% (6.7% in 2014 to 1.9% in 2017), the lowest in Australia; and a 23% reduction inhospital-acquired pressure injuryassociated costs compared with previous strategies (savings of AUD$841,791). Conclusion This research was the first in Australia to develop an approach, underpinned by the principles of translational research, to address an increasing rate of hospital-acquired pressure injuries in one local health district. This research demonstrated the approach undertaken to translate evidence into practice, naturally enhanced the uptake of evidence, empowered staff, was cost effective, led to reduced hospital-acquired pressure injuryrates and better patients outcomes in a shorter time frame than previous attempted strategies. The PARiHS framework guided the processes and enhanced the effectiveness of evidence-into-practice. Leadership, collaboration, key stakeholder buy-in were key to the success of this research.