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25 OCTOBER 2018
A Nurse-Led Evidence Based Practice (EBP) Initiative to Prevent Hospital
Acquired Pressure Injury
GABRIELLE HUTCHENS RN MAPPMGT(NURS) CPHIMS CPHQNURSING QUALITY IMPROVEMENT COORDINATOR
KING FAISAL SPECIALIST HOSPITAL & RESEARCH CENTER, JEDDAH, SAUDI ARABIA
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Declaration of
Financial Interests or Relationships
Speaker Name: Gabrielle Hutchens
I have no financial interest or relationships to disclose
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Agenda
12345
Background
The setting: KFSH&RC – Jeddah, Saudi Arabia
HAPI data
How we managed to sustain results
Interventions from Performance Improvement project
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Background
• Journey to become High Reliability Organisation (HRO)
• Transitioning from government (public) hospital to private not for profit hospital
• Zero Harm initiative started to set a new standard of excellence in the region
• Zero Harm – The only acceptable standard for harm is zero
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King Faisal Specialist Hospital &
Research Center - Jeddah2017 Statistics
1 of 3 hospitals in KFSH&RC General Organization
Hospital
385 Bed Tertiary Specialist Hospital
Demographics Population
Patients: 93% Saudi & 7% ExpatriatesNurses: More than 25 Nationalities
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Results 2016
0
0.2
0.4
0.6
0.8
1
1.2
Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16
HA
PI
rate
/ 1
00
0 p
ati
en
t d
ays
Months of the year
Hospital Acquired Pressure Injuries per 1000 patient days
Pre Intervention Post Intervention
InterventionPerformance Improvement
Project
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Interventions
Critical EBP ReviewA critical evidence based literature
review relating to decreasing HAPI was
completed.
PI ProjectA performance improvement (PI) project
utilising the FOCUS PDCA methodology.
Policy & Standards of
Practice ChangesNational Pressure Ulcer Advisory Panel
(NPUAP) Guidelines were updated in
2016 and implemented into policy.
EMR ChangesSkin integrity documentation was given
enhanced options.
Education CampaignOrganisation-wide education campaign
on HAPI prevention.
New Risk Assessment
ToolNew EBP tool “Glamorgan Pressure
Risk Assessment” was implemented.
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Interventions (cont.)
EMR Changes
Skin integrity
documentation
Education Campaign
Organisation-wide education
campaign on HAPI prevention.
New Age-Specific Risk
Assessment Tool for
Pediatrics Implemented
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Results 2018
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017 Q4 2017 Q1 2018 Q2 2018
HA
PI
rate
/ 1
00
0 p
ati
en
t d
ays
Months of the year
Hospital Acquired Pressure Injuries per 1000 patient days
Pre Intervention Post Intervention
Intervention
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Results
Sustainable results
2016, 2017, 2018Dec 2015 – above internal
trigger.
2015
Year
HAPI incident
rate/1000 patient days
Increase/
Decrease Movement
Increase/
Decrease
2015 1.1
2016 0.59 46% decrease
2017 0.24 78% decrease
2018 0.18 84% decrease
Baseline
Results
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HAPI Strategic Plan
Organisational Organisational Nursing
Zero Harm
2018 Strategic Priority:
Journey to High
Reliability
Organization
Organisational KPI
HAPI: Nursing specific
KPI reported at
executive level.
Nursing KPI
HAPI: reported KPI to
Nursing Executive,
ward level/monthly
Ward
Ward based goal
1 yearly goal must be
KPI at ward level
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Know your data!
Data must be owned by
frontline staff
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References
Select Medical UK
http://www.selectmedical.co.uk/feature
s/pain-of-pressure-ulcers/ accessed
28 Sep 2018
Image by freepik.com accessed 1 Oct
2018
Tayyib & Coyer (2016)
Willock, J., Baharestani, M.M. &
Anthony, D. (2009). The development
of the Glamorgan pediatric pressure
ulcer risk assessment scale. Journal of
Wound Care, 18 (1), pp. 17-22
https://4kpics.rocks/saudi-arabia-and-in
dia-map/ accessed 23 Sep 2018
National Pressure Ulcer Advisory Panel
(NPUAP) http://www.npuap.org/resourc
es/educational-and-clinical-resources/n
puap-pressure-injury-stages/ accessed
23 Sep 2018
Irish Association of Healthcare Assistant
s http://iaha.ie/event/1-day-training-end-
life-pressure-ulcer-awareness-preventio
n/ accessed 28 Sep 2018
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Thank youGabrielle Hutchens RN, MAppMgt(Nurs), CPHIMS, CPHQ
Nursing Quality Improvement Coordinator, Nursing Practice &
Research
Email: [email protected]