What are Pressure Injuries?
Pressure injuries are localised areas of damage to the skin and underlying tissues, usually over bony prominences. Any object in constant contact with your skin can lead to a pressure injury. They primarily result from extended pressure or a combination of pressure and shear. The injuries can present in various stages, ranging from a mild red area that disappears after pressure is relieved to severe forms involving deep tissue necrosis, exposing muscle and bone. These injuries can lead to life-threatening complications such as infections.
Why is Pressure Injury Training Important?
Early intervention to prevent pressure injuries will likely result in positive health outcomes for the person and significant cost savings to the healthcare system (Nghiem et al. 2022). Pressure injuries take a long time to heal, compromising the person’s quality of life. Education plays a vital role in preventing pressure injuries, as it empowers healthcare professionals, caregivers, and patients with the knowledge and skills needed to identify risk factors, implement preventive measures, and respond effectively to early signs of skin damage. By understanding the causes and contributing factors of pressure injuries, such as prolonged immobility, inadequate nutrition, and poor skin care, individuals can take proactive steps to minimise risks (ACSQHS 2018)
What is the Pressure Injuries Training Requirement?
The training needs for pressure injury prevention and management are clearly delineated in several healthcare standards and guidelines. According to NSQHS Actions 5.21, 5.22, and 5.23, healthcare organisations are required to provide ongoing training on the risk assessment of pressure injuries and their management. Similarly, the Strengthened Aged Care Standards 5.7.4 (c) emphasise the need for training in aged care settings (notably at end-of-life). Effective training is not merely a checkbox to meet regulatory demands; it is a cornerstone for enhancing patient safety and care quality.
Relevant Standards
Action 5.21: Pressure injury prevention and wound management systems
Organisations providing services should:
- Adapt or develop wound management systems based on best-practice guidelines
- Use screening and assessment information to prevent and manage pressure injuries
- Deisgnate individual or groups that are responsible to oversee the system
Action 5.22: Comprehensive skin inspections
- Adapt or develop processes that facilitate clinicians to perform and document comprehensive skin inspections as part of routine patient care
- a) Information about preventing pressure injuries are communicated to patients, carers and families
- b) Best-practice guidelines are followed when using pressure injury equipment, products, and devices
National Safety and Quality Health Service (NSQHS) Standards
Action 5.7.4: End-of-life care:
- c) provide pressure care, oral care, eye care and bowel and bladder care
Strengthened Quality Standards framework analysis - Aged Care Quality Standards
Pressure Injury Skills Required for Healthcare Staff
For effective prevention and management of pressure injuries, healthcare staff should be proficient in the following skills:
| Skill | Key Elements |
|---|---|
| Risk identification |
Staff should be competent in identifying patients at high risk for developing pressure injuries, taking into account factors like immobility, nutritional status, and comorbidities. |
| Assessment skills |
It is crucial to use best-practice assessment tools to assess pressure injury risk. Staff should be trained in comprehensive skin assessments, focusing on bony prominences and skin that is in contact with medical devices. |
| Implementation of preventive strategies |
Staff should be capable of selecting and employing appropriate preventive measures, such as pressure-relieving mattresses and cushions and regular patient repositioning, tailored to each patient's needs. |
| Monitoring and reassessment |
Regular surveillance for signs of pressure injuries and the effectiveness of preventive measures should be conducted. This involves visual inspections and palpation techniques to identify hidden or deep-tissue injuries. |
| Wound care and documentation |
Staff should be proficient in both basic and advanced wound care techniques, including but not limited to dressing changes, use of appropriate wound care products, and careful documentation of each step for future reference and continuous care. |
How to Assess Staff Competency in Pressure Injuries
A thorough evaluation framework for assessing the competency of healthcare staff in pressure injury prevention and management is essential. The assessment can be approached in two parts:
- Theoretical assessments: These can include written assessments featuring multiple-choice questions, and even short essay-type questions that allows the leaner to explain in rationals in further detail. Staff should be required to demonstrate in-depth knowledge of the various stages of pressure injuries, risk factors, and appropriate preventive and therapeutic measures.
- Practical assessments: Practical skills can be evaluated through observed structured clinical examinations (OSCEs), where staff are observed while performing tasks like risk assessment, patient positioning, and wound dressing.
Strategies to Support Healthcare Staff Improve Pressure Injury Skills
Once the training needs and competency levels are identified, the next step is skill development. Here are some strategies to foster staff skills:
- Regular workshops: Practical skills are best learned through doing. Regular workshops can provide staff with the opportunity to practise their skills in a safe and supervised environment.
- Peer reviews: Peer reviews add an extra layer of quality assurance and provide essential feedback for ongoing improvement. Staff members can be paired to observe, critique, and learn from one another.
- Online learning modules: Online resources can act as supplementary material that staff can refer to for brushing up their theoretical knowledge, thus reinforcing what they learn in hands-on training sessions.
- Performance metrics: Use of performance metrics can offer objective data to evaluate the effectiveness of training programmes, providing insights for further improvement.
Sample Training Plan for the Pressure Injuries Training Requirement
Ensuring staff are competent in pressure injury prevention and management is vital for your organisation to remain compliant with the Standards. Below is a sample training plan based on a mock competency assessment survey that aligns with Australian standards such as the Aged Care Standards and NSQHS.
Using the above image as an example, the skills that requires the most attention are observation and technical skills. We can target learning initiatives to fill these gaps to drive clinical staff competency.
| Quarter | Topics | Resources |
|---|---|---|
| Q1 | Assessment Skills | |
| Q2 | Wound Care and Documentation |
|
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Staff Competency Assessment for Pressure Injuries - Example
The following is an example survey that learning and development coordinators may use to asses staff competency on clinical assessment.
Staff Survey - Pressure Injury Competency
-
How would you assess a patient's risk for developing a pressure injury?
- [Answer here]
-
Name two types of pressure-relieving devices used in your practice.
- [Answer here]
-
What frequency of patient repositioning do you recommend for high-risk patients?
- [Answer here]
-
How would you document a newly discovered pressure injury?
- [Answer here]
-
Describe the steps you would take to manage an existing stage II pressure injury.
- [Answer here]
Conclusion
In summary, effective training in the prevention and management of pressure injuries is not only a regulatory requirement but a moral obligation to ensure the well-being of patients. By adhering to NSQHS and Aged Care Standards, implementing a comprehensive training programme, and regularly assessing staff competency, healthcare organisations can substantially mitigate the risk and impact of pressure injuries.
References
- Nghiem, S. Campbell, J. Walker, RM. Byrnes, J. Chaboyer, W. ScienceDirect, 2022. 'Pressure injuries in Australian public hospitals: A cost of illness study'
- Australian Commission on Safety and Quality in Health, 2023. 'NSQHS Comprehensive Care Standard'
- Australian Commission on Safety and Quality in Health, 2023. 'NSQHS Action 5.21 - Preventing and managing pressure injuries'
- Australian Commission on Safety and Quality in Health, 2023. 'NSQHS Action 5.22 - Preventing and managing pressure injuries'
- Australian Commission on Safety and Quality in Health, 2023. 'NSQHS Action 5.23 - Preventing and managing pressure injuries'
- Aged Care Quality and Safety Commission, 2023. 'Stronger Standards, Better Aged Care Program - 5.7.4 (c)
