Pressure Injury Prevention Lessons From HM17

Hospital-acquired pressure injuries remain a visible marker of how reliably a hospital turns clinical knowledge into everyday care. They affect comfort, mobility, infection risk, length of stay and discharge planning, while also placing a substantial workload on patients, families and clinical teams. Prevention therefore belongs to the whole ward, rather than to nursing documentation alone.

The education and discussion associated with Hospital Medicine 2017 offered a useful lens for this problem. Held at Mandalay Bay in Las Vegas from 1–4 May 2017, HM17 brought hospitalists, nurses and other healthcare professionals together around practical improvement, patient safety, research and continuing medical education. Its lessons translate well to Australian hospitals, where pressure injury prevention must work across metropolitan wards, regional services, aged-care transfers and remote settings.

Reducing Hospital-Acquired Pressure Injuries: Nursing-Physician Collaborative Models from HM17 is best understood as a systems approach. Nurses contribute detailed bedside surveillance and prevention expertise; physicians contribute diagnostic clarity, treatment priorities and influence over the wider plan of care. When those contributions are connected, risk is recognised earlier and prevention becomes part of clinical decision-making.

From Individual Vigilance To Shared Reliability

A pressure injury prevention programme can fail even when individual clinicians are conscientious. A nurse may identify non-blanching erythema, poor intake or prolonged bed rest, yet the concern can lose priority when the patient has competing issues such as sepsis, respiratory failure or an urgent procedure. A physician may recognise immobility as clinically significant but assume that prevention measures are already in place.

The collaborative model removes that assumption. During the ward round, the team can connect the pressure injury risk assessment with the medical diagnosis, medication plan, mobility status and expected length of stay. The nurse brings a precise account of skin condition and care delivered; the doctor confirms what can safely change, such as mobilisation, device removal, nutritional review or a revised turning plan.

This approach suits Australian practice because ward rounds often involve multiple disciplines with limited time. A brief, consistent prompt can be more useful than another lengthy form. Asking “What is putting this patient’s skin at risk today, and who is acting on it?” keeps prevention in the clinical conversation.

Build A Common Risk Picture

Reliable prevention begins with a shared assessment rather than a score viewed in isolation. Tools such as the Braden Scale can support structured thinking about sensory perception, moisture, activity, mobility, nutrition and friction or shear. They do not replace clinical judgement, especially for a patient whose condition is changing quickly.

A patient with a low score may still develop harm if a medical device presses against the skin, while someone with a moderate score may deteriorate after surgery, sedation or a long period in the emergency department. Nurses are well placed to identify these changes at the bedside. Physicians can help interpret their significance alongside haemodynamics, perfusion, cognition, medication effects and treatment goals.

Australian services also need to account for transitions between settings. A patient transferred from a rural hospital to a tertiary centre, or from residential aged care to an acute ward, may arrive with incomplete information about baseline skin condition and equipment needs. A shared admission check should record existing wounds, preventive surfaces, continence issues, nutrition concerns and the patient’s usual mobility. That information should travel with the patient rather than being recreated at every handover.

Make Prevention Visible At The Bedside

Prevention is most dependable when it is easy to see and easy to act on. The plan might specify the required support surface, heel protection, repositioning approach, moisture management, continence care, safe mobilisation and dietetic review. It should also identify exceptions: a patient who cannot tolerate a position, has unstable spinal precautions or needs a different schedule because of pain.

Physicians reinforce this visibility by treating prevention as part of the active medical plan. Orders for physiotherapy, dietetics, analgesia, delirium management or device review can remove barriers that nursing staff cannot resolve alone. Nurses, in turn, can report whether the intervention is practical and whether the patient’s skin or function is improving.

This is particularly relevant in Australian hospitals managing Aboriginal and Torres Strait Islander patients, people with disability and older adults with complex frailty. Communication about repositioning, bathing, privacy and family involvement should be culturally safe and respectful. A prevention plan that ignores a patient’s preferences, language needs or support person is unlikely to be followed consistently.

Escalation, Handover And Response

A small skin change should trigger a proportionate response, not a blame-focused investigation. The bedside nurse can describe the location, appearance, pain, duration and possible causes. The physician can assess perfusion, infection, comorbid illness and treatment priorities, then ensure that the wound plan is documented and communicated. If the cause is unclear or deterioration continues, wound care expertise should be involved promptly.

The same escalation discipline used for other forms of deterioration is valuable here. HM17’s wider clinical education included tools for recognising deterioration on general wards; the practical principles described in sepsis recognition tools also apply to pressure injury prevention: establish clear triggers, define who responds and avoid allowing an important sign to disappear in a crowded task list.

Useful handover language is specific rather than vague. “High risk” is less actionable than “sacral redness noted at 1400; barrier product applied; needs two-person turn with slide sheet; medical review requested because perfusion is poor.” The receiving clinician can then verify the plan instead of guessing what the label means.

Reliable Bedside Behaviours

• Inspect skin during admission, transfer and any significant change in condition
• Link every identified risk to a named intervention and responsible clinician
• Include devices, heels, sacrum and moisture-related damage in routine checks
• Reassess after surgery, sedation, prolonged emergency care or clinical deterioration

Sustain The Model Beyond The Ward

A collaborative model needs measurement that reflects real patient care. Hospitals can monitor the rate and stage of new hospital-acquired pressure injuries, time from identification to review, completion of risk reassessment and use of appropriate support surfaces. These measures should be examined by ward, shift pattern and patient group so that local problems are visible.

Data is most useful when it leads to learning rather than punishment. A case review might reveal that equipment was unavailable overnight, a transfer omitted the existing wound, a patient declined a position because analgesia was inadequate, or a junior doctor did not understand the significance of a device-related mark. Each finding points to a system adjustment.

For Australian organisations working under the National Safety and Quality Health Service standards, pressure injury prevention can sit within broader clinical governance, comprehensive care and partnering-with-consumers work. Local ownership matters: a nurse unit manager, medical lead, allied health representative and quality adviser can review trends together and test small changes. Rural hospitals may need equipment-sharing arrangements and telehealth wound support, while larger services may use electronic alerts and specialist teams.

Professional connection also has a place, provided it supports learning rather than distracting from it. Conference education, informal discussion and networking can help clinicians compare how different hospitals handle prevention. Even the lighter parts of a major meeting, such as the conference social programme, create opportunities for people to exchange practical ideas across disciplines. The central value of the HM17 archive remains its focus on usable knowledge, available through the HM17 conference archive.

Measures That Matter

• New pressure injuries by ward, stage and device association
• Time from documented concern to nursing and medical review
• Completion of repositioning, nutrition and equipment plans
• Patient-reported comfort, dignity and involvement in prevention decisions

The strongest lesson is that prevention becomes safer when it is treated as shared clinical work. Nurses detect subtle changes and understand the realities of bedside care; physicians connect those findings with diagnosis, treatment and escalation. Australian hospitals can strengthen that partnership through concise ward-round prompts, clear handover language, culturally safe care and measurement that supports improvement. What readers should remember is simple: a pressure injury prevention plan works when the whole team sees the risk, acts early and remains accountable together.