Towards a new agenda in pressure injury prevention: perspectives on international pressure injury policy

Abstract

BACKGROUND: Pressure injuries (PI) are associated with significant harm to patients, and carry economic consequences for the health sector. Internationally, preventing and managing PI is a key nursing activity and quality indicator. AIMS: To analyse influential policies that inform practice¬¬ related to PI management in Australia, England, Hong Kong, New Zealand, Scotland, and the United States of America. METHODS: Narrative review and synthesis of PI policies that inform practice. RESULTS: Seven national-level policy or standards documents and associated practice guidelines were identified. Primarily, the policies aimed to summarise extant evidencee and provide guidance on the prevention and management of PI. The goals of the policies almost exclusively focus upon PI risk assessment, nutritional assessment and intervention for those at risk, relief or redistribution of pressure, and optimal wound management. A number are predominately focused upon treatment approaches, with far less attention given to prevention. DISCUSSION: The predominant focus of policy is on patient risk assessment, compliance with documentation and pressure relief. Financial penalty for institutions is emerging as a strategy where pressure injuries occur. Comparisons of prevalence rates are hampered by the lack of consensus on data collection and reporting. To date there has been little evaluation of policy implementation and implemented policy strategies, associated guidelines remain founded upon expert opinion and low-level evidence. CONCLUSIONS: The pressure injury policy agenda has fostered a discourse of attention to incidents, compliance and penalty (sanctions). Prevention and intervention strategies are informed by technical and biomedical interpretations of patient risk and harm, with little attention given to the nature or design of nursing work. Considerable challenges remain if this policy agenda is to successfully eliminate pressure injury as a source of patient harm.