Abstract
Background Hospital Acquired Pressure Injuries (HAPIs) are common complications for hospitalized patients that can lead to non-healing wounds, prolonged hospitalizations, long-term care, scarring, sepsis, and death.1 In 2021, there was an alarming increase of HAPI incidences in Hamad General Hospital – Medical In-patient, which was beyond the National Database Nursing Quality Indicators (NDNQI) Magnet mean. The International Guidelines on the Prevention and Treatment of Pressure Injuries promote the importance of using other risk factors beyond the Braden scale, however, there has not been a tool shown to have an effective impact on clinical outcomes.2 This project adopted the context of Pink Paper Reminder System.3 Rapid Skin Response (RSR) aims to reduce the HAPI incidence rate in Medical In-patient by 50% (from a baseline rate of 4.14 per 1,000 patient-days to 2.07) at the end of one year (August 2022 - August 2023) by identifying the extremely high-risk patients using a modified skin assessment tool and responding rapidly through a multidisciplinary approach.
Methods Implementation of the project was in two phases, obtained and analysed with the use of the Quality Improvement Department database with concurrent Plan-Do-Study-Act (figure 1). Firstly, identifying extremely high-risk patients using RSR; Secondly, once criteria were met, a paper reminder entitled ‘SKIN AT RISK’ was hung at the head of the bed, and sets of multidisciplinary recommendations were implemented.
Results There was an 82% reduction in HAPIs following the initiation of RSR, from a rate of 4.14 to 0.75 per 1,000 patient-days (figure 2).
Conclusion The Rapid Skin Response is a cost-effective system approach that can reduce HAPIs by alerting nursing staff, physicians, and dieticians on high-risk patients, thus implementing standardized preventive measures and improving patient care.
Plan-do-study-act cycles implemented during the quality improvement project aiming to reduce hospital acquired pressure injuries (HAPIs) at Hamad general hospital, Doha, Qatar
Hospital acquired pressure injuries (HAPIs) incidents in the medical in-patient unit of Hamad general hospital, Doha, Qatar, between July 2022 and August 2023.
References
Lovegrove J, Ven S, Miles SJ, Fulbrook P. Comparison of pressure injury risk assessment outcomes using a structured assessment tool versus clinical judgement: A systematic review. Journal of Clinical Nursing 2021 Dec. DOI 10.1111/jocn.16154
Kottner J, Cuddigan J, Carville K, Balzer K, Berlowitz D, Law S, et al. Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019. Journal of Tissue Viability 2019 May;28(2):51–8. DOI: 10.1016/j.jtv.2019.01.001
Miller MW, Emeny RT, Freed GL. Reduction of hospital-acquired pressure injuries using a multidisciplinary team approach: a descriptive study. Wounds: a compendium of clinical research and practice [Internet] 2019 Apr 1;31(4):108–13. PMID: 30802207; PMCID: PMC6586476.
Ethical Approval/IRB Statement The project was approved by the Hamad General Hospital Quality Department, Doha, Qatar and exempted from an IRB review.
Disclosures and Acknowledgments The authors of the project would like to acknowledge the leaders, supervisors, and patients who were involved in the conceptualization of the project.
