Pressure Injury Prevention and Management Policy: A Critical Review and Recommendations

Assessment 2

Contents
Introduction 3
Overview of current policy 4
Consultation Activities 5
Identification of gaps 5
Staff, patient and carer meeting 5
Team formation and consultation 5
Construction of draft of internal policy 6
Expert staff review 6
Final version 6
Literature Review 7
Implementation of the policy 9
Pressure injury audit tools 11
Conclusion 11
References 12
Appendix A Updated Policy 14
1. POLICY STATEMENT 17
2. AIMS 17
3. TARGET AUDIENCE 17
4. RESPONSIBILITIES 18
5. DEFINITIONS 18

6. DOCUMENTATION 18
7. REFERENCES 19
8. REVISION & APPROVAL HISTORY 19
Appendix 2 19
PATIENT ASSESSMENT TOOL 19

Introduction
Pressure injury is defined as a confined injury to the skin which may involve the deeper tissue
and is frequently found over a bony prominence due to pressure, shear and/or friction singly
or a combination of these reasons (Australian Wound Management Association, 2014). It is a
common hospital-acquired problem which affects between 9.5 to 17.6% of individuals in
hospital at any given point (Nguyen, Chaboyer, & Whitty, 2015). An estimated 4,313
pressure injuries occurred in patients in public hospitals of Australia in 2015–16. The rate of
hospital-acquired pressure injuries in hospitals of Australia was 9.7 injuries per 10,000
hospitalisations in 2015–16 (Australian Commission on Safety and Quality in Health Care,
2018). Pressure injury is also one of the major comorbidity associated with various illnesses
of old age. Healing of pressure injuries takes longer time which adversely affects the quality
of life of older people by inflicting pain, disturbed sleep, mood disturbance restricting
mobility, and susceptibility to infection (NSW Health; Clinical Excellence Commission,
2014). They also adversely affect rehabilitation, mobility and long-term quality of life
(Clinical Excellence Commission).
Pressure injuries prolong the time in hospitals that influences the older people negatively and
increase the cost of care both due to extension of stay in the health facility and/or more
advanced care needs (National Pressure Ulcer Advisory Panel; European Pressure Ulcer
Advisory Panel (NPUAP & EPUAP), 2009). The treatment cost across all states and severity
in 2012-13 was estimated to be A$983 million per annum. Research has demonstrated
decrease in incidence of pressure injury by some hospitals by taking preventive measures
(Miles, Fulbrook, Nowick, & Franks, 2013). It suggests that the hospital-acquired pressure
injuries can be prevented or reduced by providing patient care that mitigates avoidable
clinical risks to patients.

This report is prepared to appraise the pressure injury prevention and management policy to
assess the probable areas of improvement in context with improving health outcomes for
older people. The analysis of the policy will provide the review of policy along with
recommendations to update this policy. The review and recommendations will be supported
by review literature to support the evidence-based practice.
Overview of current policy
The critical review of the NSW Health Pressure injury prevention and management policy
(PD2014_007) (CEC, 2014), will emphasize on the education and awareness of care
providers involved in management of the pressure injury. This policy is publicised on March
24, 2014 and is due to be reviewed on March 24, 2019. This policy is derived from the best
practice guidelines corresponding with Pan Pacific Clinical Practice Guideline for the
Prevention and Management of Pressure Injury 2012 (Australian Wound Management
Association, 2012). The purpose of the policy is to reduce the prevalence of pressure injuries
to NSW Health patients (CEC, 2014). Prevention of hospital acquired pressure injury is a
work in progress. The National Safety and Quality Health Service Standards (NSQHS) are
significant means of improved outcomes provisions for elderly patients (Australian
Commission on Safety and Quality in Health Care, 2012). A recent survey in NSW revealed
that in spite of Standard 8, only 60% of patients went through a detailed risk assessment
involving skin assessment and a reliable tool within 8 hours of presentation to the hospital
( Clinical Excellence Commission, 2017). Prevention and management of pressure injury can
be achieved by acting upon the Prevention and Treatment of Pressure Ulcers: Clinical
Practice Guideline. These provide detailed guidance on the actions needed to prevent
pressure injury. However, for implementation of these Guidelines, an orgnaisational focus on
policies, leadership from management and education is required (Doggett & Buck, 2018).

Therefore, this policy should be updated to implement better pressure management practice
by skilled professionals and support evidence based practice.
Consultation Activities
While updating the policy, all the stakeholders were consulted.
Identification of gaps- One of the significant aspect, which is lacking in the
comprehensive care provision to pressure injury elderly patients, is the lack of knowledge
among practitioners. The issue is education and training of the practitioners to prevent or
minimise the development of pressure injuries among older people. This could be
implemented by updating a new policy which enhances evidence based practice
(Volunteering Australia, 2006).
Staff, patient and carer meeting: Regular meetings and debate among the staff members,
patients and carer is essential to provide and receive feedback on the existing policy. It will
offer clarity in information about the existing policy and strategies to prevent pressure
injuries. The question will help to assess the understanding level and knowledge on current
policy and prevention of pressure injury among older people. It will assist in determining the
areas which needs improvement regarding pressure injuries (UOW, n.d.).
Team formation and consultation: A team of health care providers, which must include
medical officer, pharmacist, physiotherapist, and nurses, will be developed. This team will
examine the current pressure injury prevention policy and impact of practitioner’s skill and
knowledge on its pressure injury management. This consultation team assists in exchanging
information for updating the policy (University of Southern Queensland, n.d.).