Effectiveness of a Pressure Injury Clinical Judgment RIsk-Screening tool and Prevention Plan to reduce Pressure Injuries

The intervention will provide nurses with an alternative to the standard risk screening tool (Waterlow) and will involve them using their professional clinical judgement to assess pressure injury risk, and include a pressure injury prevention care plan with intervention checklist to prompt nurses in implementing preventative interventions. The plan is as per the New South Wales Pressure Injury Prevention and Management Policy. The screening tool comprises one question on risk and prompts nurses to interventions to prevent pressure injuries such as equipment, skin protection, devices and nutrition. Procedure and mode of delivery Procedure The intervention will be delivered by bedside nurses working on the study intervention wards. 1. All patients on the study wards will receive information from the bedside nurse regarding the study on admission to the ward. This will be in the form of a discussion lasting for approximately 5 minutes. 2. All nursing staff on the intervention wards will receive formal education by associate investigators of each facility on the study procedure, the pressure injury clinical judgment risk-screening tool and prevention plan prior to the commencement of the study. Formal education comprises two x 30 minute education sessions as follows: One x 30min lecture session on the study purpose, procedure and the clinical judgment risk-screening tool and prevention plan and one x 30 minute tutorial demonstration on using the tool in practice immediately after the lecture session. 3. The pressure injury clinical judgment risk-screening tool and prevention plan will be embedded in the electronic medical record for use by the ward bedside nurse. 4. Bedside ward nurses on the intervention ward will complete the tool on patients admitted to the unit. If a patient is identified as at risk, appropriate interventions will be implemented as per New South Wales pressure injury prevention and management policy. 5. Patients identified at risk of developing a pressure injury will be observed and monitored weekly for preventative interventions implemented. ARM 2 Control group The control group will have a standard pressure injury risk screening which involves nurses using the Waterlow risk tool to determine a patient's level of risk of developing a pressure injury as per the New South Wales Pressure Injury Prevention and Management Policy (https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2014_007.pdf.). Currently, New South Wales health use the Waterlow screening tool to determine a patient's level of risk for PI development. What the Waterlow does not have is a checklist of preventative interventions to prompt nurses to implement these interventions once a patient is identified at risk (the intervention tool has a checklist of preventative interventions). Intervention fidelity and adherence will be monitored by a researcher-developed checklist comprising all elements of the intervention. This will be completed by ward nurses on the study intervention wards three times a week.