Speakers
Description
Research indicates that patients with darker skin tones are often diagnosed with higher-stage pressure injuries due to inaccurate assessments and delayed identification (Black, et al., 2023). Trillium Health Partners (THP), a 1500-bed community hospital, has prioritized pressure injury prevention since 2019, achieving a sustained reduction in overall hospital-acquired pressure injuries (HAPI) well below the national benchmark.
In 2023, THP began to focus on early identification of pressure injuries in patients with darker skin tones aligned with RNAO Best Practice Guidelines. This initiative included updating standards and policies for prevention, assessment, and management of stage 1 and 2 injuries to incorporate staging across diverse skin tones. Education was enhanced for new staff during orientation, wound care education offerings for all staff and for our leadership teams. Further, recognizing patient diversity, THP implemented the Monk scale in pressure injury audits to capture critical data on varying skin tones, addressing a notable gap in the literature and healthcare resources.
With these interventions in mind, a significant decrease in HAPI was observed from March 2023 (4.8%) to September 2023 (2.8%) and sustained to the March 2024 audit (3.9%). Notably, there was also a decrease in both the frequency and severity of pressure injuries amongst patients with Monk scale ratings of 6-9 in the March 2024 audit (four stage 2) compared to previous audits in September 2023 (six stage 4, three unstageable) and March 2023 (one stage 1, eight stage 2, six stage 3, one deep tissue injury). These outcomes indicate improved HAPI prevention efforts in darker skin tones, and suggest promising results aligned to the quintuple aim.
Tailored education and policies focusing on pressure injury staging across skin tones can decrease the incidence and severity of pressure injuries. Broader education on nursing assessment is essential for delivering holistic care to our diverse community.
Keywords
EDI, pressure injury, prevention, monk scale, HAPI
What RNAO BPG or tool/toolkit is this work related to:
Registered Nurses’ Association of Ontario (2016). Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition. Toronto, ON: Registered Nurses’ Association of Ontario.
Registered Nurses Association of Ontario (2011). Risk Assessment & Prevention of Pressure Ulcers. Registered Nurses Association of Ontario. www.rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
Author(s) Credentials and Title
Allison Da Silva, RN, BScN, NSWOC, WOCC (C), Nurse Clinician- Skin/Wound/Ostomy, Critical Care
Jameal Reid RN, BScN, MAEd, Manager, Professional Practice, Skin, Wound and Ostomy, Policies & Authorizing Mechanisms
Wendy Campbell BScPT, MEd, Manager, Professional Practice, Interprofessional Scholarly Development
| Organization Name | Trillium Health Partners |
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