Preventing and managing pressure injuries in SMHS

South Metropolitan Health Service (SMHS) promotes a culture of zero harm, including zero harm from pressure injuries.

About pressure injuries
A female clinical nurse talks to an older male patientA pressure injury is a sore, break or blister of the skin caused by constant, unrelieved pressure on an area of the body over a long period. The depth of skin damage can vary from shallow to very deep. Pressure injuries can be very painful and take a long time to heal. They may also reduce a patient’s mobility.

The elderly are at most risk of pressure injuries, but they can occur in any patient or in any setting, including:

  • acute areas such as operating theatres
  • during transportation to a hospital
  • intensive care units.

The majority of pressure injuries are preventable; however those at greater risk include the frail, elderly or people who have:

  • been confined to a bed or chair
  • poor bladder or bowel control
  • diabetes, poor circulation or a history of smoking
  • reduced mental awareness due to illness, medications or anaesthetics
  • poor diet or fluid intake.

Pressure injuries may impact significantly on a patient’s:

  • length of hospital stay
  • comfort and quality of life
  • cost of care and health outcomes.

To prevent pressure injuries and to work towards zero harm from pressure injuries, SMHS patients are screened for pressure injuries on presentation or admission to hospital. Following admission, SMHS patients are risk assessed regularly to ensure pressure injury prevention strategies are in place as required. SMHS hospitals use a tool called the ‘Braden scale’ to assist staff to predict a patient’s risk for pressure injuries and then manage this risk in line with best practice guidelines. Read more information about reducing your risk of developing pressure injuries during your hospital stay (external site)

Measuring pressure injuries

Pressure injury classification systems provide a consistent and accurate means to communicate and document the severity of a pressure injury between clinical staff. The international classification system for pressure injuries grades these types of wounds in stages depending on:

  • changes in the patient’s skin
  • the depth of the injury
  • if there is any fluid draining from the wound.

Pressure injuries are measured as an inpatient pressure injury rate using how many patients developed one or more stage 2 or greater pressure injuries (a stage 2 injury is when there is a break in the skin or a blister forms) during their hospital stay, divided by the number of beds occupied by patients each day (occupied bed days).

Pressure injury-related clinical incidents measure those pressure injuries that were not present on the patient’s admission to hospital and are therefore considered hospital acquired.

Benchmark rates

In Australia, one estimate of the frequency of pressure injury ranged from:

  • 5.6 per cent to 48.4 per cent (average 25.5 per cent) in acute and sub-acute health care facilities
  • 4.5 per cent to 36.7 per cent in acute care facilities.

SMHS promotes a safety culture of zero harm, including zero harm from pressure injuries

As there is currently no national or state agreed inpatient pressure injury rate benchmark, SMHS sites and services use the Australian Council for Healthcare Standards (ACHS) annual peer rate as the benchmark for inpatient pressure injuries which are greater than or equal to stage 2. 

The ACHS annual peer rate provides a comparison based on a yearly average across all Australia/New Zealand organisations participating in the ACHS Clinical Indicator Program. The most recently published ACHS annual peer rate is for 2015 and equates to less than or equal to 0.73 inpatient pressure injuries per 1,000 occupied bed days.

When a SMHS hospital’s pressure injury rate does not meet the agreed benchmark a review is undertaken and an action plan is developed to address the issue/s.  For example, Fiona Stanley Hospital has implemented a number of strategies to address their pressure injury rate.

See how we measure up

The graph below shows the inpatient pressure injury rate for each of the SMHS hospitals:

  • FHHS – Fremantle Hospital and Health Service
  • FSH – Fiona Stanley Hospital
  • RkPG – Rockingham Peel Group
  • PHC – Peel Health Campus

Coloured bar graphs and other charts are used to display data.  When comparing data it is important to exercise caution, as hospital activity varies between sites.

Rate of inpatient pressure injuries (≥Stage 2) per 1,000 occupied bed days by quarter

The SMHS inpatient pressure injury rate averaged 0.59 from April 2016–June 2017. This is below the target rate of 0.73 inpatient pressure injuries (≥stage 2) per 1,000 occupied bed days.

What these figures show?
  • The SMHS inpatient pressure injury rate averaged 0.59 from April 2016–June 2017. This is below the target rate of 0.73 inpatient pressure injuries (≥stage 2) per 1,000 occupied bed days.
  • Fremantle Hospital and Health Service had an inpatient pressure injury rate of 0.32 through 2016 and January–March 2017. For the April to June 2017 quarter the rate is 0.40 inpatient pressure injuries
  • The inpatient pressure injury rate for Fiona Stanley Hospital has averaged 0.85 from January 2016–March 2017. For April to June 2017, this rate decreased to 0.67 inpatient pressure injuries.
  • Rockingham Peel Group had an average inpatient pressure injury rate of 0.29 through 2016 and January–March 2017. For the April–June 2017 quarter the rate is 0.13 inpatient pressure injuries.
  • The inpatient pressure injury rate for Peel Health Campus was 0.06 in January–March 2017. In the April–June 2017 quarter the rate is 0.29 inpatient pressure injuries.