ArticleBMJ open quality2026
Quality education initiative to reduce pressure ulcers in high-risk-admitted patients in low-resource settings.
Article in BMJ open quality, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundPressure injuries, although preventable, are a persistent challenge for admitted patients in hospitals globally, especially in low-resource settings. High-risk patients include the elderly, the immobile and those with terminal illness. A hospital-wide quality education initiative was launched at a tertiary care hospital after an increasing trend of pressure injuries was seen among inpatients across different units. This initiative aimed to assess the effectiveness of a simple, easy-to-use Turning Clock Tool to reduce the occurrence, severity and undesired outcomes of pressure injuries.
methodsThe quality education initiative was implemented over 6 months in three stages: the preintervention stage from 1 November 2023 to 31 January 2024, the implementation and training stage during February 2024, and a postintervention stage from 1 March 2024 to 31 May 2024. All inpatients admitted for at least 24 hours were included in the study. Nurses and caregivers were trained on the use of the tool to reposition patients every 2 hours. The incidence of pressure injuries, location, staging and the duration of hospital stay were compared before and after the implementation of the tool.
resultsThere was a 77.36% reduction in the incidence of pressure injuries from 53 to 12 cases. All stage-3 pressure injuries were eliminated while a significant decrease in stage-4 pressure injuries was seen. The gluteal and sacral regions were the most affected parts of the body. Patients with advanced age were the most affected. Average length of stay dropped from 11 days to 5 days.
conclusionThe Turning Clock Tool evaluated effectiveness, feasibility and contextual significance for preventing pressure injuries in low-resource hospital settings. Its use not only decreased the incidence and severity of pressure injuries but also reduced the average length of hospital stays. The Turning Clock Tool can be used as a simple yet cost-effective model to prevent pressure injuries in similar resource-constrained settings globally.
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