If you are a patient at St Vincent’s Hospital Melbourne, you will find yourself sitting in a very comfortable chair. Thanks to the Best Care for Older People (BCOP) initiative, every patient chair at the hospital is now equipped with a custom designed pressure relieving cushion. The initiative is reducing the incidence of pressure injuries via a preventative health approach.
Pressure injuries are largely preventable. They are painful, difficult to treat, costly and can have severe adverse consequences for those experiencing them. However, they still occur in hospitals every day.
"Even if there's one person we prevented from a pressure injury, then it's worth it."
The use of pressure relieving equipment, such as pressure reducing cushions and heel wedges has been shown to reduce the likelihood of pressure injuries forming. However, preventable injuries can often occur because appropriate pressure relieving equipment is not available unless a patient is deemed high risk or has already sustained an injury. Additionally, staff are not always aware of when or how to use the equipment available, or how to monitor patients’ skin integrity.
St Vincent’s Hospital Melbourne was no exception. An audit revealed that 92 per cent of inpatient units did not have sufficient pressure-relieving devices available. Equipment was hired when needed, a costly and inefficient exercise.
The innovative approach to preventing pressure injuries taken by St Vincent’s came about organically. Natalie Newman, a BCOP Project Officer and Amber O’Brien, an Occupational Therapist, met to discuss a project to help nursing staff decide when and what type of pressure relieving cushions to provide to patients. As they explored the types of cushions available, they decided they needed to further understand the impact of extended unsupported sitting and the pressure relieving devices available.
Natalie and Amber mapped the pressure on the sacral area for a person sitting on a standard hospital chair using an image mapping system. The results were surprising, clearly showing very high areas of pressure particularly on the sacrum. Mapping the pressure areas while using available cushions showed that none were right for the job. Not content with this, they set about designing their own. Collaborating with patients, infection control and an external manufacturer they came up with a suitable design. The new cushion reduced pressure by a massive 65 per cent.
Realising the potential impact of such a huge reduction in pressure, they decided that all patients, not just those deemed at high risk, would benefit from access to this equipment. “Once we realised that everyone could benefit from these cushions, then we ran with it and it turned into an organisational strategy” says Natalie.
With funds available through BCOP, 560 of the custom designed pressure cushions, as well as 200 heel wedges, were purchased and the pair set about introducing them to every acute and sub-acute inpatient ward. The approach meant that all patients sitting out of bed would be on a pressure relieving cushion at all times, no matter how low risk they might be. High risk patients would still be referred for assessment by Occupational Therapy and further interventions introduced if necessary. All wards were also provided with enough heel wedges for patients confined to bed for long periods.
Crucial to the success of the roll out was the extensive education campaign – over 500 staff attended tutorials on the preventative approach to pressure injuries and the use of the cushions. In addition, over 750 educational posters were distributed, and all inpatient units were provided with an information pack about the cushions, including infection control, maintenance and ordering. This comprehensive approach meant that the roll out went smoothly with everyone understanding the purpose and requirements of the new practice.
The approach to pressure injury prevention has become part of daily clinical practice at SVHM. The ongoing responsibility for maintaining the initiative has been taken up by the Occupational Therapy Department and the Nurse Unit Managers of each ward. Occupational Therapy staff now work with Nurse Unit Managers to assess the condition of the cushions and replace them as necessary. They are also champions of the policy and work to ensure it remains standard practice throughout the hospital. The Occupational Therapy Department even keeps a supply of cushions for patients to purchase and use at home.
This groundbreaking approach to preventing pressure injuries has already shown impressive results. Just six months after the roll out was completed, pressure injuries of all types were reduced by 34 per cent. Not only that, but the severity of the injuries that did occur were reduced across the board.
Recognition of the effectiveness of the initiative has come from far and wide. St Vincent’s Health Australia awarded the project a Quality Award in 2013 for Exceptional Care – A culture of no harm. Several other organisations have also expressed interest in adapting the initiative for their own use.
Not only that, but the custom designed pressure relieving cushions developed by SVHM have proved very popular with other healthcare providers, due to the evidence based development process. They have been so effective that their manufacturer has now made them their standard.
Perhaps, however, the worth of the initiative can be gauged more simply - as Natalie says, “even if there’s one person we prevented from a pressure injury, then it’s worth it.”