Pressure injury prevention practices among medical surgical nurses in a tertiary hospital: An observational and chart audit study

Abstract

Pressure injuries are frequently occurring adverse events in hospitals, negatively impacting patient safety and quality of care. Most pressure injuries are avoidable if effective prevention strategies are used. However, the extent to which various settings influence their use of prevention strategies is unknown. The aim of this study was to describe and compare pressure injury prevention strategies used by medical and surgical nurses in the Chinese context. In this observational study, we used semi‐structured observations with chart audits to collect data in two medical and two surgical wards in a tertiary hospital from June to December 2020. Observations were patient‐focused; any prevention practices the patient received were recorded, and a chart audit was used to identify documented prevention strategies. The frequency of each prevention strategy was reported, and differences between medical and surgical wards were analysed using independent t ‐test or χ 2 test. A total of 577 patients (n = 294, 50.9% medical; n = 283, 49.1% surgical) were observed and their charts audited. Risk assessment was completed on admission for all patients. Repositioning was the most frequently used strategy, with about 84% (n = 486) patients being repositioned regularly. However, skin care, nutritional risk screening and the use of support surfaces were suboptimal. Patient education was not commonly observed but was documented in 75% (n = 433) of audited charts. More medical patients' skin was kept clean and hydrated, but more surgical patients received barrier creams, had a support surface and received more nutrition support and if a prone position was used, they were more likely to be turned after 2 hr and to be repositioned after sitting in a chair for an hour. Prevention strategies were more likely to be documented in surgical patients' charts. Despite pressure injury prevention guideline recommendations provided various prevention strategies for nurses to apply, the observed use of some strategies such as nutrition, skin care and support surfaces was not ideal. Nurses relied heavily on repositioning for pressure injury prevention. Most pressure injury prevention practices need improvement although surgical patients generally received better preventative care. These findings can facilitate clinicians and nurse managers when tailoring future pressure injury prevention work.

Registered nurses’ approach to pressure injury prevention: A descriptive qualitative study

“…We found nurses generally regarded risk assessment to be a top priority when planning and delivering PIP. This finding resonates with the findings of previous studies that risk assessment is the initial step to guide nurses to plan PIP (Hultin et al, 2021; Li et al, 2021). In our study, in addition to the use of a structured tool, nurses also consider their ‘clinical judgment’ during risk assessment.…”

“…Several studies have explored PIP care in China (Li et al, 2021;Liu et al, 2019). The compliance rate for repositioning was 90% with immobile patients in a cross-sectional study (Liu et al, 2019), much higher than that reported in Sweden (44.3%) (Baath et al, 2014) and Australia (66.4%) (Chaboyer et al, 2017).…”

“…The compliance rate for repositioning was 90% with immobile patients in a cross‐sectional study (Liu et al, 2019), much higher than that reported in Sweden (44.3%) (Baath et al, 2014) and Australia (66.4%) (Chaboyer et al, 2017). A recently published observational study also identified high completion rates of repositioning and risk assessment in a Chinese tertiary hospital, however, nurses' uptake of strategies such as providing an appropriate support surface, skin care and nutrition were less ideal (Li et al, 2021). The combination of low reported rates of PI along with variable PIP practices implies a need for a deeper understanding of Chinese nurses' approach to PIP.…”

“…However, researchers have shown compliance with various PIP recommendations is suboptimal in western countries (Barker et al, 2013; Chaboyer et al, 2017; Latimer et al, 2016). Several studies have explored PIP care in China (Li et al, 2021; Liu et al, 2019). The compliance rate for repositioning was 90% with immobile patients in a cross‐sectional study (Liu et al, 2019), much higher than that reported in Sweden (44.3%) (Baath et al, 2014) and Australia (66.4%) (Chaboyer et al, 2017).…”

Neuromuscular blocking agents and opioids are major risk factors for developing pressure injuries in patients in the intensive care unit

“…In a recent, large-scale, 1-day point prevalence study, the prevalence of ICU-acquired pressure injuries was 16.2% in 1,117 ICUs in 90 countries worldwide [ 4 ]. Once these pressure injuries occur, they are difficult to cure and can prolong hospitalization stay, increase health care costs, cause complications such as infection and pain, and lower patient quality of life [ 5 – 7 ]. Recently, an increase in mortality has been reported in patients who had developed pressure injuries during ICU admission; the mortality rate increased even more in patients who had a higher stage of ulcer [ 4 , 8 ].…”