October 2017 April 2016

Te Puawai pressure injury committee in place and 1 DHB had a pressure injury prevention information leaflet available (Weststrate, 2015). Process indicators Measuring compliance with process is the second important aspect in pressure injury prevention. The new 2014 pressure injury guidelines provide us with the most up to date information about what should be included in the pressure injury prevention process and what to avoid (Haesler (Ed.), 2014). An example of this is the guideline to “use a structured approach to risk assessment that is refined through the use of clinical judgment and informed by knowledge of relevant risk factors”. This highlights that clinical judgement is a critical factor in the risk assessment process beyond ticking boxes on the pressure injury risk assessment scale. The aspects of the process are the use of pressure reducing material like cushions and mattresses, providing the client with information, checking the nutritional and hydration status, the need for regular turning schedules etc. These general guidelines need to be translated to the day to day practice for the individual ward on which they will be used. Measuring compliance with the prevention process is critically important to explain the outcomes. Outcome indicators Measuring the outcome is important as it tells us whether we achieved what we predicted in the first place. Without connecting outcome to the structure and process indicators, they are all disconnected bubbles floating in the air, open to random interpretations. The danger is that quality outcome indicators are going to act as performance outcome indicators which ignores asking WHY? There are a number of outcome indicators to focus on in the prevention of pressure injuries. Internationally a difference is made between category I pressure injuries and category II,III and IV pressure injuries. With category I pressure injuries the skin is intact and by relieving the pressure the non-blanchable erythema is still reversible. At category II and higher the skin is broken down and treatment is needed. Other outcome indicators are deterioration of the pressure injury category. This may highlight that the method of prevention is not effective for this client. New Zealand Are pressure injuries a burden for the New Zealand healthcare system? It all depends on who you ask. The wound care specialist will acknowledge the problem is huge. ACC received 349 treatment injury claims during the years 2012-2013, the 2014-2015 serious adverse event report shows that 19 pressure injuries are reported as serious adverse events (Health Quality & Safety Commission, 2015). The interRAI data tells us a pressure injury prevalence of 8.4% on the 31.000 residents that © Te Puawai College of Nurses Aotearoa (NZ) Inc 5

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