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

External fixation is widely used in treating complex fractures and limb reconstruction. Pin site infections remain a significant complication, impacting on patients' physical and psychosocial wellbeing. This clinical improvement project at a University Hospital in Denmark aimed to enhance pin site care by involving patients and caregivers throughout the treatment pathway.

At our hospital, approximately 55 trauma patients are annually treated with lower limb external fixators. Pin site care is crucial for preventing serious infections/osteomyelitis and involves collaboration between hospital and municipal caregivers. Traditional pin site care in our unit was complex and time-consuming, causing patient anxiety and frequent unplanned clinic visits.

Inspired by the Participatory Design research methodology, a quality improvement project was conducted in three phases: (1) identifying users' needs, (2) developing solutions collaboratively, and (3) testing/evaluating these solutions. Iterative cycles of planning, acting, observing, and reflecting were employed, facilitating mutual learning among participants. Interviews with patients, families and healthcare professionals and field observations both at the hospital and in the municipality were conducted. Inspiration was sought from international literature.

Phase 1 identified the need for improved education about infection recognition, a less painful and time-consuming dressing method, and an assessment tool for pin site infection. Phase 2 involved extensive user input to develop and implement a new dressing procedure using PolyMem™ along with an assessment tool. Phase 3 evaluated the new methods, revealing reduced patient pain, fewer clinic visits, and stable infection rates as well as less time-consuming pin site care.

The project successfully enhanced pin site care, involving users in developing a new care process, thus improving patient satisfaction and care efficiency.

Incorporating patient perspectives and collaborative methods can significantly improve clinical care pathways. Future efforts should focus on further integrating patient centered and participatory approaches in healthcare improvements.