Authors (including presenting author) :
LAU KH, Chan KY, Chan KI, Yu WM, Tang SL, Shang ST, Fung C
Affiliation :
Intensive Care Unit, United Christian Hospital
Keyword 1: :
Hospital-Acquired Pressure Injury
Keyword 2: :
Nursing Round
Keyword 3: :
Pressure Relieving Device
Keyword 4: :
Pressure Injury Prevention
Keyword 5: :
Self-improvement
Introduction :
Hospital-acquired pressure injuries (HAPI) can severely impact critically ill patients in Intensive Care Units (ICUs). To address this issue, various pressure-relieving devices (PRDs) were introduced at United Christian Hospital (UCH) ICU. Initially, the implementation led to a decrease in pressure injury incidence. However, an upward trend in HAPI cases was noted in January 2025. The UCH ICU Skin and Wound Care Team hypothesized that improper application of PRDs contributed to reduced effectiveness. Consequently, a thorough analysis was undertaken to identify causes and develop enhancement measures.
Objectives :
• To improve compliance and accuracy in the application of PRDs.
• To enhance the effectiveness of pressure relief provided by PRDs.
• To increase nursing competence in PRD application and raise awareness of pressure injury prevention.
• To reduce the incidence of HAPIs in the UCH ICU.
Methodology :
The ICU Skin and Wound Care Team developed a comprehensive framework and checklist focused on clinical scenarios to assess the accuracy and efficacy of PRD application in critically ill patients. Briefing sessions were organized for all Advanced Practice Nurses (APNs) in the ICU, equipping them with essential knowledge about the characteristics and best practices for effective PRD use. 30-minute surprise rounds were conducted following patient repositioning to ensure PRDs were applied correctly. APNs provided immediate coaching and constructive feedback to bedside nurses during these rounds when they observed misapplications.
Result & Outcome :
Nursing rounds on PRDs began in November 2024, with an average of 70 ICU patients reviewed monthly, increasing to 134 patients by October 2025. Prior to the implementation of these rounds, 7 HAPIs were reported in October 2024. From November 2024 to April 2025, reported HAPIs fluctuated between 1 and 9 (averaging 5.6 per month). However, from May 2025 to October 2025, the number of reported HAPIs ranged from 0 to 4 (averaging 2.3 per month). These findings illustrate a clear inverse relationship between the number of patients assessed during nursing rounds and the incidence of HAPIs. Furthermore, the efficiency of APNs in conducting PRD rounds improved, while both the competence of ICU nurses and awareness regarding HAPI prevention significantly increased. Most notably, the average incidence of reported HAPIs in the UCH ICU demonstrated a marked decline.
