Use of a risk-based intervention bundle to prescribe and implement interventions to prevent pressure injury: An observational study.
Paul Fulbrook, Josephine Lovegrove, Saroeun Ven and 2 others
PMID 38969344WHAT IT FOUND
Most pressure injury interventions were prescribed for 341 inpatients, but implementation was often undocumented or not observed.
Check that prescribed skin checks, nutrition referrals, patient education, and equipment are actually delivered.
Key findings
01For all interventions, documented implementation rates were lower than prescription rates, and this difference was statistically significant for all but three interventions.
02Patient/carer discussion was prescribed for 84.6% of patients and documented for 8.6%; the management plan was prescribed for 78.7% and documented for 6.8%; the brochure was prescribed for 66.3% and documented for 1.8%.
03Heel elevation devices and bariatric equipment were implemented for only 27.9% and 7.7% of patients for whom they were prescribed.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The audit was at one hospital, so the rates may not apply to other settings. Data were collected over 2 days from a convenience sample of adult inpatients in occupied beds, and emergency, intensive, mental health and palliative care patients were excluded. There was no before bundle comparison, so the study cannot show that the bundle reduced pressure injuries or changed practice. For many interventions, implementation evidence came from charts or notes rather than direct observation, so missing documentation may not always mean care was not delivered. The pressure injury status was not documented for 12 patients, and the Waterlow score was incomplete in 28.4% of cases. Assessors worked in pairs, but formal interrater reliability of the data collection tool was not assessed. The study did not investigate why prescribed interventions were not implemented or documented.
Declared interests
The study was unfunded, and the authors declared no conflict of interest.
The easy way to misread this
Do not read the 1.2% hospital-acquired pressure injury prevalence as evidence that the bundle works. The study had no before comparison, and many prescribed interventions were not documented as implemented.