Background Over 700,000 patients are affected by pressure injuries in the UK every year (Wood, Brown, Bartley, et al. BMJ Open Qual. 2019 Aug 20;8(3):e000409), and it is estimated that the incidence of pressure injuries within palliative care is 11.7% (Ferris, Price, Harding. Palliat Med. 2019; 33(7): 770–782). There is evidence that education can reduce the incidence of new pressure injuries (Kim, Park, Kim. Adv Skin Wound Care. 2020;33(3):1–11), but improvements may only be temporary without cultural change (Yan, Dandan, Xiangli. Int Wound J. 2022; 19(2): 262–271). In 2014, we carried out training with all registered nurses and health care assistants, and encouraged all staff to be involved with pressure injury prevention and treatment. Over the following year, there was a significant reduction in the number of pressure injuries that developed in the hospice. This project, initiated in 2014, has continued over the past eight years, and with the results monitored regularly.

Aims To ensure that the initial reduction in pressure injuries was maintained, and identify the interventions required to make these improvements permanent. To demonstrate that involving health care assistants (HCAs) in all aspects of wound care is beneficial to patients, carers, and other health professionals, and that these improvements could be maintained over the longer-term.

Method Annual mandatory training days and induction days, focusing on preventative care and early signs of skin breakdown. Strong engagement with team in discussion of new products and pilot trials. Emphasis on using prophylactic dressings. Tissue viability leads spend time every week working with staff. Feedback and reflection about the results achieved. Questionnaire to patients, carers, and health care professionals to ascertain views about HCAs carrying out skin and wound assessments and applying dressings. Regular interviews with patients and carers to elicit feedback on services, including skin and wound care.

Results Initial and subsequent questionnaires and interviews have shown strong support for HCAs’ involvement in wound care.

Conclusions Involving unregistered staff in pressure wound assessment and treatment is an important part of an effective pressure injury prevention programme. Regular training and support can maintain good results over the long-term. Feedback suggests that patients, carers, and health professionals see the benefit of this approach, and job satisfaction and morale among HCAs has increased. Our results demonstrate that this project has brought about significant and permanent improvements in the prevention of pressure injuries.