Pressure injury (PI) – or the injuries or wounds to the skin and / or underlying tissue that develop from pressure, friction or shear to the skin – is a […]
Pressure injury (PI) – or the injuries or wounds to the skin and / or underlying tissue that develop from pressure, friction or shear to the skin – is a global patient safety problem. Incidence rates reported by studies around the world ranged from 5% to 32% in ICU patients.
Left unchecked, this condition leads to considerable pain and discomfort for patients, lengthening hospital stays and increasing burden and costs for hospitals.
For The People’s Hospital of Deyang City (PHDC), located in China’s Sichuan province, data from 2018 revealed that incidence of PI in Deyang stood at 0.13%, significantly higher than the average in Sichuan province (0.027%) or nationwide in China (0.012%).
The hospital thus set out to analyse the causes behind this. They observed that there was a lack of standardised management strategy and measurements for PI in the city. There was also ineffective management of PI in local primary hospitals, due to uneven distribution of medical resources and generally weak primary care quality.
Setting up a regional care alliance
As a leading hospital in Deyang, PHDC took action to establish a regional pressure injury care alliance, led by the hospital’s Trauma Repair Centre.
“(Establishing such) medical clusters has become one of the effective solutions to optimise the structural distribution of medical resources, promote the vertical integration of medical resources, guide the hierarchy of medical care and improve the service capacity of primary hospitals,” said the hospital.
Other steps taken include creating a standardised PI management model for the facilities within the alliance, comprising evidence-based PI protocols, care procedures and risk assessment tools.
Indicators to evaluate the quality of PI care were also developed, based on Donabedian’s “structure-process-outcome” quality management model.
The hospital led comprehensive training to raise the skill level of specialist nurses in PI prevention and treatment, through online and offline channels. For supervisors, a PI checklist was developed to ensure key PI prevention and control processes were not omitted.
The alliance also served as a platform for sharing and discussions on cases encountered and ideas for improvement. Quarterly case sharing, for example of difficult PI cases, were held to enhance case management ability.
Since implementation, the alliance had developed six SOPs for PI care, including SOPs for patients in prone position, or for tube protection. Across 11 hospitals, a total of 35 specialists, 35 wound specialist nurses and over 60 PI liaisons have received focused training.
In terms of benefits to patients and medical facilities involved, the hospital shared that:
- Implementation of PI preventive measures rose from 78.53% to 90.16%;
- Patient health education awareness rose from 82.67% to 89.96%;
- PI incidence decreased from 0.04% to 0.019%;
- PI recovery rate improved from 29.53% to 42.37%
The hospital also engaged the wider community in this effort. More than 10 national, provincial and municipal-level continuing medical education programmes were conducted for over 1,000 medical professionals, and voluntary consultations for over 300 people. Their efforts were picked up by local media platforms such as Health Deyang, and promotional posts on the hospital’s WeChat account received over 6,000 views.
With the project’s success, the hospital has shared their experience and resources with five hospitals outside the region, with the goal of achieving win-win collaborations in healthcare.
Looking back at the project, PHDC noted that it proved how medical cluster and regional alliances can achieve standardised care management, which in this case greatly improved PI prevention and control.
“As a platform for optimising the structure of medical resources and enhancing the capacity of primary health services, medical clusters have been actively explored in countries around the world,” said the hospital.
“By building the specialist care alliance platform, this project leverages on the medical cluster to develop a whole chain management strategy of PI care homogenisation. It promotes the homogenisation of specialty care, enhances the scientific and standardised prevention and treatment level of PI, reduces the incidence of PI and has high socioeconomic benefits. It is worthy of further promotion and application.”
Nominations for HMA Awards 2022 are now open! This year, awards will be handed out in seven categories, including Patient Experience Improvement, Infection Control Excellence, Clinical Effectiveness Improvement, Most Advanced Healthcare Technology, and more. For more details, click here.