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Appropriate Pressure Prevention Loan Equipment (APPLE) Project

Western NSW Local Health District
Project Added:
21 September 2015
Last updated:
20 October 2015

The Appropriate Pressure Prevention Loan Equipment (APPLE) Project


The APPLE project developed a new process to obtain and store APAMs at Orange Health Service (OHS). Patients identified at 'high risk', those who have an existing pressure injury and/or those who are clinically indicated, are provided with pressure relieving equipment in a timely manner.


Within six months, 100% of patients at OHS who are provided with pressure-relieving equipment will have documented evidence of its suitability.


  • Improves patient outcomes, quality and safety of care.
  • Improves efficiency in service delivery and appropriate use of APAMs.
  • Initiates agreed process to obtain and store APAMs with supporting Local Operational Procedures (LOP).
  • Provides accurate data for APAM usage at OHS.

Program status

Program dates

  • Start: 1 April 2015
  • Finish: 31 October 2015

Program status

Implementation - The initiative is ready for implementation, is currently being implemented, piloted or tested.


NSW Health policy, guidelines and national accreditation standards recommend that patients are assessed for pressure injury risk within eight hours of presentation. Patients identified at 'high risk' of developing a pressure injury, those with an existing injury and/or those who are clinically indicated should have an appropriate pressure relieving mattress or seating within two hours of assessment.


OHS moved to a new facility in 2011, which had 160 inpatient beds and rented APAMs at a considerable cost. Prior to the implementation of the project, APAMs were scattered across the facility, with no clear process to obtain one when required. Patients on the APAM often had no risk assessment or clinical indication documented, or had a level of risk below what was required to receive an APAM.

Between August and October 2014, the Wound Care Clinical Nurse Coordinator (CNC) at OHS tracked the usage and appropriateness of use of APAMs at OHS on a twice-weekly basis. Data showed poor compliance during this period, with an average appropriate APAM usage according to documented risk level of 53%.


On 1 April 2015, a new process to obtain and store APAMs at OHS was implemented across all wards. This aimed to support timely availability of pressure-relieving equipment and ensure appropriate use. Interventions included:

  • developing and distributing a process flowchart and draft LOP to all wards at OHS
  • identifying and labelling APAMs in the storage area. All APAMs were numbered and those not in use were moved to the 'mattress pool'
  • developing a PowerPoint presentation outlining the new process for nurse educators and ward leads, with in-service sessions provided by the Wound Care CNC. This also provided an opportunity to deliver education on pressure injury risk assessment requirements
  • engaging Spotless staff regarding the new process, with feedback and suggestions incorporated in the flowchart and LOP
  • daily recording of APAM usage by the Spotless Supervisor, which is a 24/7 service at OHS. Information was entered on database at the end of each month by the Wound Care CNC.

Implementation sites

Orange Health Service, WNSWLHD.


  • Time spent by the Wound Care CNC tracking and recording APAM usage and appropriateness of usage across all wards at OHS was reduced from 16 hours a month to one hour a month. As a result, the Wound Care CNC has more time to devote to patient care, quality improvement activities and ongoing education for OHS clinicians.
  • There was a significant improvement in the documentation of risk levels for patients who received an APAM, with average compliance increasing from 53% prior to the project to 95% post-implementation.
  • The use of APAMs increased from an average of 28 per day in 2014 to 33 per day in 2015.
  • The Emergency Department is now ordering APAMs for patients prior to transferring them to the ward.
  • Data will be collected in a number of ways to evaluate the success of the project, including monthly APAM usage, annual point prevalence surveys, regular audits and a review of pressure injuries in the Incident Information Management System (IIMS).
  • The data will be reviewed at monthly OHS Pressure Injury Prevention steering committee meetings. A further audit of appropriateness of APAM usage will be conducted six months post implementation.

Lessons learnt

  • The varying priorities and busy workload of the numerous stakeholders required flexible, ongoing and open communication to sustain the success of the project.
  • It’s important to have all resources ready for implementation, as this can take considerable time. Ongoing support to promote the new process should be provided by the Wound Care CNC.


Joe Webster
Clinical Nurse Coordinator
Wound Care, OHS
Phone: 02 6369 7455

Maree Connolly
Pressure Injury Prevention Project, Project Officer
Clinical Excellence Commission
02 6369 3837

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