Improving risk assessment and prevention of pressure injuries during the implementation of a best practice clinical guideline

Abstract

Objective: To evaluate the indicators of quality of care in pressure injuries (PI) before and after 6 months of the implementation of the Good Clinical Practice Guideline of the Registered Nurses' Association of Ontario in the geriatric unit of the Hospital Universitari Santa Maria de Lleida.

Method: Longitudinal descriptive observational study throughout the implementation of the Good Clinical Practice Guideline (GCP) "Risk Assessment and Pressure Injury Prevention" carried out by the Ontario Nurses' Professional Association. The main variables - incidence and category of nosocomial pressure injuries, risk assessment of PI during the first 24hours of admission and risk level according to the EMINA scale, continuous assessment according to the risk of PI and special surface for pressure management recorded in the care plan - were extracted from the electronic medical records for subsequent descriptive analysis and hypothesis contrasting for comparison of proportions.

Results: A total of 154 subjects were included, most of them being women (57%), average age of 86 years and an average stay of admission of 8 days. With the implementation of the guide it was possible to improve, not always with statistical significance, the quality indicators: the incidence of PI decreased by 14.54%, risk assessments of PI 24hours after admission increased by 2.90%, while periodic risk assessments increased by 280.35%, recording 48.19% compared to 12.67% for the baseline situation. In addition, the recording of special surfaces in patients at risk of PI also increased by 13.33%.

Conclusions: The implementation of the RNAO GCP improved the results related to the assessment and prevention of PI, with a positive impact on the quality of care indicators.

Keywords: Evidence-based practice; Guía de práctica clínica; Indicadores de calidad de la atención de salud; Lesión por presión; Practice guideline; Pressure injury; Práctica clínica basada en la evidencia; Quality indicators health care.