Impact of Pressure Injury Prevention Protocol in Home Care Services on the Prevalence of Pressure Injuries in the Dubai Community

Abstract

Background: Pressure injuries (PIs) in the community have emerged as a health care burden in the past few years, leading to high rates of morbidity and mortality among the elderly population. There is evidence that simple risk assessment tools and protocols have reduced the prevalence of PIs considerably by shifting the focus to timely prevention and adequate management. The prevalence of PIs is high in home care setting and utilizes a major share of the organizational resources for its treatment and prevention. Aim: This study aims to assess the impact of the newly developed PI prevention protocol for home care patients in Dubai. The objectives are to evaluate effective implementation of the proposed protocol and its impact on the prevalence of PIs in the community to identify the gaps for improvement in the future. Methods: This retrospective observational was conducted in 13 primary health care centers in Dubai, UAE. Data were collected from 249 patients' records at an average age of 75.5 ± 14.5 years old with compromised mobility (bedbound/chairbound) from January to July 2019. The PI prevalence was assessed before and after 6 months of implementing the PI prevention protocol and comparison was done using a standardized skin assessment scale (Braden Scale). Internationally validated tools from the Agency for Healthcare Research and Quality and National Institute for Health and Care Excellence were used to ensure the reliable use of the Braden Scale and PI protocol compliance. The prevalence was calculated from the existing key performance indicators in the home care office and considering the significant improvement at p value of <0.05. Results: The findings in the first quarter revealed a significant drop in both prevalence (9.0%) and incidence rate (6.0%) to approximately 2.0%. Overall PIs prevalence declined significantly after implementing the protocol (p < 0.0001) among both genders. Also, a significant improvement was detected in the use of Braden Scale and multidisciplinary care plan (p < 0.0001). Conclusion: This study indicates that standardization of care delivery reduces the increased risk and incidence of PIs with a potentially positive outcome on PI prevalence.