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We investigated nurses' experiences of hospital‐acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence‐based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital‐acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self‐blame related to PI identification, and exacerbating impacts of the COVID‐19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital‐acquired PI. [ABSTRACT FROM AUTHOR]

Aim(s): To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury. Design: Exploratory. Methods: Scoping review. Data Sources: Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021). Results: Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3). Conclusion: Quality of evidence was low for the interventional studies and best practice recommendations. Implications for the Profession and/or Patient Care: Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations. Impact Statement: This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment. [ABSTRACT FROM AUTHOR]

Background: Care navigation is commonly used to reduce preventable hospitalisation. The use of Electronic Health Record‐derived algorithms may enable better targeting of this intervention for greater impact. Aims: To evaluate if community‐based Targeted Care Navigation, supported by an Electronic Health Record‐derived readmission risk algorithm, is associated with reduced rehospitalisation. Methods: A propensity score matching cohort (5 comparison to 1 intervention cohort ratio) study was conducted in an 850‐bed Victorian public metropolitan health service, Australia, from May to November 2017. Admitted acute care patients with a non‐surgical condition, identified as at‐risk of hospital readmission using an Electronic Health Record‐derived readmission risk algorithm provide by the state health department, were eligible. Targeted Care Navigation involved telephone follow‐up support provided for 30 days post‐discharge by a registered nurse. The hazard ratio for hospital readmission was calculated at 30, 60 and 90 days post‐discharge using multivariable Cox Proportional Hazards regression. Results: Sixty‐five recipients received care navigation and were matched to 262 people who did not receive care navigation. Excellent matching was achieved with standardised differences between groups being <0.1 for all 11 variables included in the propensity score, including the readmission risk score. The Targeted Care Navigation group had a significantly reduced hazard of readmission at 30 days (hazard ratio 0.34; 95% confidence interval: 0.12, 0.94) compared with the comparison group. The effect size was reduced at 60 and 90 days post‐discharge. Conclusion: We provide preliminary evidence that Targeted Care Navigation supported by an Electronic Health Record‐derived readmission risk algorithm may reduce 30‐day hospital readmissions. [ABSTRACT FROM AUTHOR]