Regents Garden

A. Braden Risk Assessment Training - Comprehensive training was provided to all nursing staff during regular nurse meetings to improve knowledge and accuracy in completing the Braden Risk Assessment and to ensure its appropriate application in clinical practice. 

B. Braden Risk Assessment Clinical Pathway - Occupational therapists, physiotherapists, the Clinical Nurse Specialist (CNS), and the Flagship project team across the Regents Garden Group collaborated to develop a standardised Braden Risk Assessment Clinical Pathway. The pathway provides clear guidance on the appropriate timing and frequency of Braden Risk Assessments, together with the corresponding pressure injury prevention interventions required for each risk category. 

C.  Pressure injury prevention education – A comprehensive pressure injury prevention education program was delivered to strengthen the knowledge and skills of both care and nursing staff. This multidisciplinary education program significantly improved staff knowledge, clinical assessment skills, and confidence, promoting consistent evidence-based pressure injury prevention practices throughout the facility.

D.  Weekly resident health status meetings were attended by the project team, occupational therapists (OTs), physiotherapists (PTs), facility nurses, clinical managers, and the facility manager to review changes in residents' conditions and identify those at risk of pressure injuries using the Braden Risk Assessment Clinical Pathway. For residents identified as being at high risk, a multidisciplinary team (MDT) approach was implemented, involving OTs, PTs, dietitians, podiatrists, Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), nurses, care staff, residents, and residents' representatives to develop and implement individualised care plans aimed at reducing pressure injury risk. Collaborative care is a key component of the Braden Risk Assessment Clinical Pathway and has now been embedded into routine clinical practice.

E. Resident and family engagement - The project was introduced at resident meetings, where the project team provided education on pressure injury prevention, explained the purpose and expected benefits of the initiative, and highlighted how residents could take an active role in maintaining their skin health. Residents were encouraged to report any discomfort, pain, redness, or changes in skin condition to staff as early as possible. Where appropriate, they were also supported to participate in repositioning and mobility activities to help reduce pressure injury risk and promote comfort. Feedback from residents and families was actively encouraged and valued, with suggestions reviewed by the project team and incorporated into ongoing quality improvement activities where appropriate. This ongoing communication and partnership approach strengthened transparency, supported shared responsibility for pressure injury prevention, and promoted a person-centred model of care. It also helped foster a collaborative culture between residents, families, and the multidisciplinary team, with a shared focus on improving outcomes and enhancing quality of life.

The project achieved several significant outcomes that strengthened pressure injury prevention practices at Regents Garden Scarborough. The successful implementation of this initiative has established a sustainable model of care that is expected to be expanded across the wider Regents Garden Group. 

Outcomes include: 

• Evidence-based clinical resources developed and embedded into routine practice 
• A multidisciplinary Pressure Injury Prevention Team has strengthened communication, accountability, and continuity of care 
• Targeted education, bedside coaching, and ongoing support significantly improved staff knowledge, confidence, and awareness of evidence-based pressure injury prevention practices 
• Staff have developed a more positive attitude towards pressure injury prevention and recognised the importance of early identification, timely risk assessment, and prompt intervention to prevent skin deterioration.  
• Compliance with pressure injury risk assessments and preventative interventions increased through regular auditing, performance feedback, and active management oversight.  
• Stronger culture of proactive skin assessment, early intervention, multidisciplinary collaboration, and shared accountability, enabling staff to identify residents at risk earlier and implement timely preventative measures.  
• Residents and their families increase awareness and engagement in pressure injury prevention.  
• Increased resident participation promoted independence, enhanced mobility, improved skin health, and reinforced a shared partnership between residents, families, and the multidisciplinary team in preventing pressure injuries. 

Analysis of four months of implementation data demonstrated substantial improvements in both process and clinical outcomes: 

• 100% of nursing staff and 80% of care staff completed pressure injury prevention education. 

Routine audits showed improvements across all key components of the bundle: 

• Repositioning: increased from 66% to 89%, indicating that residents at risk were repositioned more consistently according to recommended schedules. 
• Skin checks: increased from 5% to 54%, reflecting a significant improvement in the routine assessment of residents' skin integrity and earlier identification of pressure injury risk. 
• Equipment checks: increased from 5% to 60%, demonstrating more consistent use and monitoring of pressure-relieving equipment to reduce prolonged pressure and support skin protection. 
• The incidence of pressure injuries decreased by 72% during the implementation period. 
• Timely completion of Braden Risk Assessments improved from 29% at baseline to 99%, with assessment accuracy improved from 13% to 96%, demonstrating substantial improvements in compliance and documentation quality. 

These outcomes demonstrate that the project not only achieved its intended objectives but also established a sustainable and scalable model for improving pressure injury prevention across aged care services within the Regents Garden Group. 

The project will be further strengthened, sustained, and embedded across the Regents Garden Group through ongoing staff engagement, strong clinical leadership, and a structured governance framework. Following the successful implementation at Regents Garden Scarborough, the evidence-based pressure injury prevention model, including the Braden risk assessment clinical pathway, daily skin bundle care, pressure injury high-risk register, multidisciplinary review process, and governance structure, has been adopted as the organisational standard for pressure injury prevention. 

Building on lessons learned and positive outcomes achieved at Scarborough facility, the project will be progressively rolled out across the remaining Regents Garden facilities in a staged, sustainable manner. Standardised policies, clinical pathways, education resources, audit tools, and reporting processes developed through the Flagship 2 Project will support consistent implementation and enable continuous monitoring of outcomes. To further strengthen workforce capability and ensure long-term sustainability, annual pressure injury prevention education and competency assessments will continue for all clinical care staff. Regular audits, performance reporting, outcome monitoring, and continuous feedback will support sustained compliance, continuous quality improvement, and the successful organisation-wide replication of the Flagship 2 Project, ultimately improving pressure injury prevention outcomes for residents across all Regents Garden facilities. 

The project's positive outcomes demonstrate the value of embedding evidence-based pressure injury prevention into routine aged care practice. For aged care, the project has improved the quality, safety, and consistency of care by enabling earlier identification of residents at risk of pressure injuries, promoting timely preventive interventions, and reducing avoidable harm. The implementation of standardised clinical pathways and multidisciplinary care planning has also enhanced person-centred care and supported better health outcomes for older people. For the aged care workforce, the project has increased staff knowledge, skills, and confidence in pressure injury prevention through education, practical training, and ongoing clinical support. It has strengthened collaboration and communication among nurses, care staff, and allied health professionals, fostering a proactive, team-based approach to care. By embedding sustainable, evidence-based practices into everyday clinical care, the project has also enhanced workforce capability and prepared the organisation to meet the expectations of Australia's aged care reforms and evolving quality standards. 

This project provided our team with valuable learning opportunities. We gained greater insight into the relationship between accurate data collection, clinical analysis, and resident outcomes. The project encouraged a more proactive approach to care and reinforced the importance of multidisciplinary collaboration, communication, and continuous quality improvement. 

The experience also increased staff awareness of pressure injury prevention strategies and strengthened confidence in using data to support evidence-based decision-making. As a team, we learned that sustainable improvement requires engagement, education, and shared accountability across all levels of care.