Prevention and management of hospital-acquired pressure injury among patients with lung disease in a hospital: a best practice implementation project.

OBJECTIVES: The aim of this project was to promote evidence-based practice in the prevention and management of pressure injury in lung disease patients. INTRODUCTION: Pressure injury is a crucial quality indicator for hospital care of patients. The pressure injury incidence threshold in the chest wards has been exceeding that of the general ward (0.128%), which may extend patients' hospital stay. METHODS: Clinical audits were performed using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice (GRiP) audit and feedback tool. Twelve audit criteria representing best practice recommendations for preventing and managing pressure injury among lung disease patients were used. A baseline audit was performed to measure the degree of consistency between existing practice and best practice. This project used the GRiP analysis and multiple strategies to develop care protocols for pressure injury prevention and management. A follow-up audit was conducted to measure changes in clinical practice and pressure injury incidence. RESULTS: Postimplementation audit compliance rates improved for the following criteria: skin assessment for identifying pressure injury indications (from 31 to 81%), identification of pressure injury risk score/category (from 19 to 88%), employment of nutritional assessment tools (from 8 to 93%), and provision of information regarding oral nutritional supplements (from 23 to 84%). Furthermore, patients learning the pressure injury care protocols (from 48 to 93%), the receipt of additional skin protection measures, and repositioning of vulnerable areas to relieve pressure increased to 100 and 93%, respectively. After project implementation, the monthly pressure injury incidence decreased markedly from 0.075 to 0.021%. CONCLUSION: The success factors of this project are attributable to leadership, open communication, multiple learning-by-doing strategies, regular audits, and the promotion of patient and family engagement.

Effects of systematic nursing instruction on a low-phosphorus diet, serum phosphorus level and pruritus of patients on haemodialysis.

AIMS AND OBJECTIVES: To investigate the effectiveness of systematic nursing instruction on a low-phosphorus diet, serum phosphorus level and pruritus of haemodialysis patients. BACKGROUND: A high number of end-stage renal disease patients on haemodialysis are bothered by pruritus. Hyperphosphataemia was reported to be related to pruritus. DESIGN: An experimental design was applied. METHODS: Ninety-four patients who received haemodialysis between September 2013 and December 2013 at a medical centre in Taipei, Taiwan, were recruited. An experimental group received individual systematic nursing instruction by the investigator through a nursing instruction pamphlet and reminder card for taking medication. A control group received traditional nursing instruction. The pruritus, blood phosphorus level and five-day diet records were evaluated before and after intervention. RESULTS: The experimental group had a low-phosphorus diet intake compared with the control group (p < 0·001). A significant difference in serum phosphorus level was observed between the experimental and control groups (p = 0·002). Incidence of pruritus was lower in the experimental group than in the control group (p < 0·001). CONCLUSION: A systematic nursing instruction included using a pamphlet, pictures and reminder cards, the patients' blood phosphorus levels decreased, the patients consumed more low-phosphorus food, and pruritus decreased. RELEVANCE TO CLINICAL PRACTICE: This study recommends that clinical nursing staff include systematic nursing instruction as a routine practice for dialysis patients.