Pause on Pressure: Educate. Prevent. Empower. is a quality improvement initiative designed to enhance pressure injury prevention through re-examining the core reasons why pressure injuries are occurring and looking at how patients and their families can collaborate with the interprofessional team within the healthcare setting. Through discussion on the foundational elements leading to pressure injury formation and through the use of an iterative

process, nursing students from Georgian College will co-create and pilot innovative, low-cost educational approaches that engage patients and families as active partners in pressure injury prevention. This project emphasizes shared ownership and innovative approaches to encourage collaboration between staff, patients, and families.

Expected Outcomes & Deliverables:

Project Goals

• Reassess assumptions: Determine root causes for why pressure injuries are occurring and why current interventions may not engage patients and families to participate in pressure injury prevention.

• Create innovative educational approaches: Develop and prototype patient and family oriented interventions which can be implemented without additional technology or budgetary requirements. These interventions should be reflective of the patient population cultural, linguistic and literacy considerations. (i.e. staff badges with educational quick tips for patients and families, teach-back checklist, visual aids, etc.)

• Promotion of shared responsibility: Prevention requires a team including the patient and their families and where able encouraging patients’ engagement in prevention such as regular skin checks, and positioning along with staff support.

• Iterate rapidly and refine: Utilizing an agile-inspired approach to change management, considering multiple feedback loops, this will allow quick testing of educational methods, gather user input, and revise concepts in a short period of time.

• Consider sustainability: determine the most practical and effective strategies to implement into routine workflows to promote sustainability of the interventions over time.

Proposed Process and Timeline:

1. Planning and review phase (10-15 hours)

• Conduct an environmental scan meeting with educators, wound/ostomy clinical nurse specialist, and frontline nurses to ask “Why do patients get pressure injuries during their admission?” and “How can the patient and family assist in their prevention?”

• Review the guidelines and research evidence regarding pressure injury prevention and current education and strategies used for pressure injury prevention at RVH.

• Identify gaps in patient and family participation.

2. Iterative development cycles (40-50 hours in 2-3 sprints)

• Brainstorm and prototype interventions: Develop potential new solutions or redesigned

resources (i.e. checklists, visuals, booklets, etc.)

• Pilot interventions and gather feedback: Trial interventions developed with patients, families, and staff obtaining data to support their efficacy and opportunities for improvement.

• Refinement of interventions: Incorporate feedback obtained into interventions.

3. Piloting and evaluation (20-25 hours):

• Introduce the updated interventions to a larger group of nurses or pilot the interventions on unit(s) within the acute care setting.

• Educate staff on the interventions and collect data on implementation and barriers

• Evaluate the efficacy and usability of each intervention from staff, patient and family perspectives.

4. Final recommendations and sustainability (10-15 hours)

• Develop a report outlining the interventions, what was effective, what was not, and why

• Present findings from the project discussing ongoing integration of project findings into hospital polices and practices.

• Identify a roadmap for future improvements and further developments beyond the project.

Expected Outcomes

1. A co-designed “toolkit” or collection of resources: The project will lead to the development of a set of educational approaches that have been tested and refined within the clinical setting. Educational resources may include items such as paper based resources, visual aids such as videos, or newly conceived methods from brainstorming underlying principles of pressure injury development and through communication with staff.

2. Evidence of patient and family engagement: Qualitative or basic quantitative data showing increased patient and family participation in pressure injury prevention where able (i.e. notification of the need for incontinence management, notification of the need for positioning, area of discomfort notification, etc.).

Qualitative nurse feedback will be obtained regarding the feasibility of the approaches long-term and if they foster a sense of shared responsibility.

3. Development of an implementation and sustainability plan: Development of a report identifying recommendations on the integration of successful approaches into workflow and strategies for monitoring and sustaining the approaches to ensure they remain relevant after completion of the project.

4. Student and organizational learning: Students will gain experience in an iterative quality improvement process, first-principles thinking, change management, interdisciplinary teamwork, and wound prevention and management. The organization will benefit from innovative, patient-centered solutions to prevent pressure injuries and educate and assist staff with education of patients and families without costly new technologies.

Student Involvement:

• Assessment and exploration: Students will conduct an initial environmental assessment, conducting stakeholder interviews, observe current patient and family education and resource processes, and facilitate a workshop focused on understanding the first principles and core assumptions of pressure injuries.

• Co-design and test: Students, in small working groups will brainstorm possible interventions and develop rapid prototypes and collect direct feedback.

• Train and engage staff: Gather frontline input and feedback on the new approaches and determine feasibility of implementation. Communicate the new strategies with staff during huddle and through developed communications.

• Data collection and presentation: Develop and deliver a presentation for leadership outlining project outcomes, noting successes and challenges, and identifying next steps for future expansion and broader roll-out.

Resources Required:

• Access to unit-based workflows, staff huddles, and patient/family education materials as well as observing patient and family interactions and conducting pilot testing.

• Support from wound/ostomy clinical nurse specialist and nurse educators to validate content and keep interventions feasible and clinically accurate.

• Support to develop and distribute print and digital materials (e.g., signage, video, etc.)

• Collaboration with interdisciplinary teams (e.g., dietary, therapy, patient education)

• Approval to engage with patients and families for feedback, with appropriate supervision

Additional Comments:

This project supports patient safety initiatives, enhances nurse-led education, and encourages shared accountability in pressure injury prevention and provides students with meaningful experience in quality improvement, interdisciplinary teamwork, insight into wound prevention and management and health literacy- focused content creation. Using an agile approach to change management this project while remaining structured in its objectives while remaining flexible and creative in its development of innovative interventions encouraging continuous learning and real-time adaptability, appropriate for a setting such as acute care, rather than a singular

one-time resource launch.

Support Offered:

• Weekly mentorship meetings with project lead

• Support and guidance with onsite tasks

• Access to subject matter experts and frontline clinicians for feedback (e.g., wound/ostomy clinical nurse specialist)

• Sprint check-ins and final feedback sessions to guide development and presentation