Effectiveness of a Pressure Injury Clinical Judgment RIsk-Screening tool and Prevention Plan to reduce Pressure Injuries

INTERVENTION: The intervention will provide nurses with an alternative to the standard risk screening tool (Waterlow) and will involve them using their professional clinical judgement to assess pressure injury risk, and include a pressure injury prevention care plan with intervention checklist to prompt nurses in implementing preventative interventions. The plan is as per the New South Wales Pressure Injury Prevention and Management Policy. The screening tool comprises one question on risk and prompts nurses to interventions to prevent pressure injuries such as equipment, skin protection, devices and nutrition. Procedure and mode of delivery Procedure The intervention will be delivered by bedside nurses working on the study intervention wards. 1. All patients on the study wards will receive information from the bedside nurse regarding the study on admission to the ward. This will be in the form of a discussion lasting for approximately 5 minutes. 2. All nursing staff on the intervention wards will receive formal education by associate investigators of each facility on the study procedure, the pressure injury clinical judgment risk‐screening tool and prevention plan prior to the commencement of the study. Formal education comprises two x 30 minute education sessions as follows: One x 30min lecture session on the study purpose, procedure and the clinical judgment risk‐screening tool and prevention plan and one x 30 minute tutorial demonstration on using the tool in practice immediately after the lecture session. 3. The pressure injury clinical judgment risk‐screening tool and prevention plan will be embedded in the electronic medical record for use by the ward bedside nurse. 4. Bedside ward nurses on the intervention ward will complete the tool on patients admitted to the unit. If a patient is identified as at risk, appropriate interventions will be implemented as per New South Wales pressure injury prevention and management policy. 5. Patients identif CONDITION: Injuries and Accidents ‐ Other injuries and accidents Prevention of pressure injuries;Pressure injuries; ; Prevention of pressure injuries ; Pressure injuries Public Health ‐ Health service research Skin ‐ Other skin conditions SECONDARY OUTCOME: Length of hospital stay (outcome assessed from medical records).[On discharge or transfer from ward ] The severity of the new pressure injury (outcomes assessed from patient study‐specific questionnaire instrument) . [30 days from admission] Time to pressure injury development (outcomes assessed from patient study‐specific questionnaire instrument)[30 days from admission] INCLUSION CRITERIA: All patients who do not have any pre‐existing pressure injuries on admission, who are admitted to the selected wards during the study period will be eligible to participate. Participants will remain in the study until discharge. PRIMARY OUTCOME: The development of the first new pressure injury, of any stage, in patients without pre‐existing pressure injuries, as defined by the National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel (2014) international staging system. Outcomes are assessed from patient data collection instrument (patient study‐specific questionnaire instrument).; The patient study‐specific questionnaire instrument is a study specific questionnaire which was developed for a previous study by the researchers to reduce pressure injuries. This instrument was developed in consultation with registered nurses and reviewed for face validity by senior researchers and senior registered nurses. The instrument captures information on patient demographics, time and date of data collection, diagnosis and comorbidities, skin assessment data for example erythema, blanching response, location and pressure injury information including, stage size, depth, location, exudate. The instrument was tested on ten patients by three senior nurses; a minor amendment was made to the instrument to include operational definitions of skin assessments.; ; [Hospital‐acquired pressure injury occurrence within a 30‐day period ]