Large-Scale Coordinated Prevention of Pressure Injuries in Public Hospitals

PURPOSE: The purpose of this retrospective study was to evaluate the effect of an organization-level, hospital-acquired pressure injury (HAPI) prevention program over a 15-year period. A secondary aim was to summarize the program priority areas, and the resources used to inform and support its delivery. DESIGN: Retrospective statewide audit. SUBJECTS AND SETTING: Sixteen hospital and health services in Queensland, Australia, provided HAPI-related indicator data between 2013 and 2018, involving up to 4245 hospital inpatients each year. METHODS: A retrospective evaluation was undertaken using statewide audit data from up to 121 hospitals collected annually between 2003 and 2018. Outcomes of interest were HAPI prevalence and related indicators (n = 6). Priority focus areas of the program and supporting resources were extracted from annual reports, strategic plans, meeting minutes, and an internal publishing database. RESULTS: Following commencement of the program in 2006, HAPI prevalence decreased from 14% to 3% in 2018, with corresponding improvements in all 6 related indicators. Program focus areas and supporting resources were multifaceted and evidence based, targeting organizational policy, guidelines, equipment use, procurement, clinical tools, and education. A range of data sources informed the annual program focus including audit, evaluation, and pressure injury clinical incident data. CONCLUSION: The formation of a statewide HAPI prevention program coincided with a sizeable reduction in HAPI prevalence. This evaluation demonstrates that large-scale quality improvement programs to reduce HAPIs can be effective and sustainable.