Increasing Pressure Reliefs and Decreasing Hospital-Acquired Pressure Injuries Through A Therapy-Nursing Education Program

Research Objectives: To educate nursing staff on use of dependent tilt-in-space and power wheelchairs to increase comfortability and competency of managing specialty equipment, and thus, to carryover pressure relief best practices for patients who use aforementioned wheelchairs out of bed.

Design: Collected data from October 1, 2022- June 25, 2023 of registered nurse (RN)/certified nursing assistant (CNA) full-time and per diem staff in an inpatient spinal cord injury (SCI) unit. Utilized a pre-post survey tracking RN/CNA competence/comfortability (0 = no confidence; 5 = fully comfortable/competent) in operating and performing pressure reliefs in a power or tilt-in-space wheelchair, and on low air loss (LAL) mattress. RNs/CNAs completed a standard training program instructed by physical and occupational therapists focusing on equipment and on mobilizing patients for pressure reliefs and optimal sitting. RNs/CNAs completed a post-test after training.

Setting: SCI unit in inpatient rehabilitation setting

Participants: Participants included nursing staff on SCI unit (n = 30). Observational subjects include patients on SCI unit

Interventions: PT/OT led didactic and hands-on standard training program educating nursing staff on pressure relief considerations: operating power and tilt-in-space wheelchairs, timing requirements, identifying bony prominences, turning patients/maintaining proper positioning, and accurately setting LAL to appropriate weight. Created job aides (visual/written instructions on how to operate power and tilt-in-space wheelchairs) and placed on RN Workstation On Wheel (WoW) carts to improve carryover.

Main Outcome Measures: Pre-post self-assessment measuring competency/comfortability of RNs/CNAs managing speciality wheelchairs and and re-positioning patients in bed

Results: Study revealed significance pre-post in power wheelchair pressure relief (t = -4.235), p< 0.001; tilt in space pressure relief (t = -5.174), p< 0.001; bed repositioning (t = -3.756), p=0.001; and wheelchair re-positioning (t = -4.980), p< 0.001. Additionally, no new incidences of Stage II or greater HAPI’s were identified in the analyzed post-training time period.

Conclusions: Study findings revealed the training program increased competence/comfortability in nursing staff to perform pressure reliefs in speciality equipment. Thus, there is potential for improving nursing-therapy education to facilitate pressure relief protocols on an inpatient SCI unit.

Author(s) Disclosures: N/A