Group at table for safety huddle
The Unit S4 team at Toronto Rehab, Bickle Centre, collaborates to revise an individualized care plan. (Photo: UHN)

When Veroneike Buntin was approached to have her unit pilot implementation of the prevention bundle for pressure injuries in the Complex Continuing Care Program at the Toronto Rehab, Bickle Centre, she was thrilled with the opportunity and knew her team was ready for the challenge.

"As a collaborative team, we pride ourselves on being able to manage and heal complex wounds," says Veroneike, Program Manager of Unit S4, an in-patient unit for patients with complex care needs. "In recognizing the work required to prevent pressure injuries from occurring altogether, we were excited to be a part of this groundbreaking project that would change clinical practice and keep patients safe."

And, that's just what it's done. Bickle's Unit S4 has just celebrated 173 days without a pressure injury.


caring safety logo

Pressure injuries are a Hospital Acquired Condition (HAC), which is something that causes harm to patients but is preventable through highly reliable performance. As part of Caring Safely at UHN, six HACs have been prioritized based on their impact to patients and the organization: pressure injuries, falls, C. difficile infection, central line infection, adverse drug events and surgical site infection.

Each HAC has identified one or more prevention bundles, which are a group of standards and supporting practices that, when used consistently with the Error Prevention Tools, have been proven to reduce preventable harm and improve patient outcomes.

It's Caring Safely Week at UHN. This year's theme is "Celebrating our Safety Successes!"

Unit S4, a 24-bed unit, was one of those that piloted the pressure injuries prevention bundle and HAC implementation framework. Learnings from this team helped inform the auditing process, as well as the education and supporting materials required to effectively implement it on other units.

Team has exceeded all expectations

Typically patients on the unit have been diagnosed with brain injury, stroke or spinal cord injury resulting in severe neurological impairments along with a multitude of co-morbidities.

All the patients have chronic impairment and many have severely limited mobility and are unable to communicate or assist in their care. These patients are among the most vulnerable with high care needs.

The pilot involved forming an interprofessional, unit-based HAC working group that identified goals and developed a plan to work towards preventing pressure injuries, sharing at daily huddles and in meetings, conducting audits and supporting staff in the implementation of the pressure injury prevention bundle.

At the time the pilot began, the unit was averaging three pressure injuries per month. Three months later, the number had started to decline and the team continued planning ahead and collaborating with one another, leading to the prevention of pressure injuries altogether.

Reaching 173 days without a pressure injury shows success that has exceeded all expectations.

Things team members have done to curtail pressure injuries include:

  • Scanning for safety risks every time they enter a patient's room
  • Discussing the management of patient's mobility, seating and repositioning with interprofessional team, including occupational therapists and physiotherapists
  • Establishing turning, repositioning and seating schedules that are patient centered and consider the risk of developing a pressure injury
  • Ensuring bony prominences, which are bones close to the surface of the skin, such as elbows, heels and the tailbone, are protected from pressure that could cause injury
  • Providing education to patients and families regarding the plan of care to prevent pressure injuries.

"We now have a better understanding of other team members' roles and contribution," says physiotherapist Fahreen Ladak. "And I have an increased confidence in my own role in the prevention of pressure injuries."

Today, the unit has daily reminders in safety huddles with the interprofessional team that feature the pressure injury prevention bundle and ensuring individualized care plans are in place for all patients. 

Although these practices are not new to the team, they have now become formalized practice for all staff.  Consistency and teamwork has been key to the unit's success.

"The new state has not changed my practice, but the process feels more collaborative because everyone is aware of the importance of an interdisciplinary approach to preventing and managing pressure injuries," says Jennifer Whitelaw, a registered dietician.

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