Improving external fixator pin site care through user involvement: A quality improvement project

Area of Science:

• Orthopedics
• Patient Care Improvement
• Clinical Research Methodology

Background:

• External fixation is vital for complex fractures and limb reconstruction, but pin site infections are a significant complication.
• Annual treatment of approximately 55 patients with lower limb external fixators highlights the need for effective pin site care to prevent infections like osteomyelitis.
• Traditional pin site care was complex, time-consuming, and caused patient anxiety, necessitating a review of current practices.

Purpose of the Study:

• To enhance pin site care for patients undergoing external fixation by involving patients and caregivers.
• To improve the efficiency and patient experience of pin site care through a collaborative quality improvement project.
• To reduce complications, patient anxiety, and healthcare resource utilization associated with external fixation pin sites.

Main Methods:

• A three-phase quality improvement project inspired by Participatory Design methodology.
• Involved iterative cycles of planning, acting, observing, and reflecting with patients, families, and healthcare professionals.
• Utilized interviews, field observations, and literature review to identify needs and develop solutions, including a new dressing procedure and assessment tool.

Main Results:

• Identified needs for better infection education, simpler dressing methods, and an assessment tool.
• Developed and implemented a new PolyMem™ dressing procedure and an assessment tool with extensive user input.
• Observed reduced patient pain, fewer clinic visits, stable infection rates, and more time-efficient pin site care.

Conclusions:

• The project successfully enhanced external fixation pin site care through user involvement.
• The new care process improved patient satisfaction and overall care efficiency.
• Collaborative, patient-centered approaches are effective in improving clinical care pathways.