title: Towards international consensus on patient harm: perspectives on pressure injury policy.
abstract: OBJECTIVE
  To analyse influential policies that inform practice related to pressure injury management in Australia, England, Hong Kong, New Zealand, Scotland and the United States of America.
  
  
  BACKGROUND
  Pressure injuries are associated with significant harm to patients, and carry economic consequences for the health sector. Internationally, preventing and managing pressure injuries is a key nursing activity and quality indicator.
  
  
  RESULTS
  Comparative review and synthesis of pressure injury policies that inform practice.
  
  
  RESULTS
  The predominant focus of policy is on patient risk assessment, compliance with documentation and pressure relief. Financial penalty for institutions is emerging as a strategy where pressure injuries occur. Comparisons of prevalence rates are hampered by the lack of consensus on data collection and reporting. To date there has been little evaluation of policy implementation and implemented policy strategies, associated guidelines remain founded upon expert opinion and low-level evidence.
  
  
  CONCLUSIONS
  The pressure injury policy agenda has fostered a discourse of attention to incidents, compliance and penalty (sanctions). Prevention and intervention strategies are informed by technical and biomedical interpretations of patient risk and harm, with little attention given to the nature or design of nursing work. Considerable challenges remain if this policy agenda is successfully to eliminate pressure injury as a source of patient harm.
authors.affiliation: Oxford Brookes University, Oxford, UK. djackson@brookes.ac.uk.|Oxford University Hospital NHS Foundation Trust, Oxford, UK. djackson@brookes.ac.uk.|University of New England, Lismore, New South Wales, Australia. djackson@brookes.ac.uk.
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Southern Cross University, Lismore, New South Wales, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Hutchinson
authors.affiliation: University of Nebraska Medical Center, Lincoln, Nebraska, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Barnason
authors.affiliation: The University of Hong Kong, Hong Kong, China.
authors.forename: William
authors.initials: W
authors.lastname: Li
authors.affiliation: Western Sydney University, Sydney, New South Wales, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Mannix
authors.affiliation: Auckland University of Technology, Auckland, New Zealand.
authors.forename: Stephen
authors.initials: S
authors.lastname: Neville
authors.affiliation: University of New England, Lismore, New South Wales, Australia.
authors.forename: Donella
authors.initials: D
authors.lastname: Piper
authors.affiliation: University of Technology Sydney, Sydney, New South Wales, Australia.
authors.forename: Tamara
authors.initials: T
authors.lastname: Power
authors.affiliation: Edinburgh Napier University, Scotland, UK.
authors.forename: Graeme D
authors.initials: GD
authors.lastname: Smith
authors.affiliation: University of New England, Lismore, New South Wales, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Usher
mesh_terms: D001315:Australia; D032921:Consensus; D004739:England; D006291:Health Policy / Q000639:trends*; D006723:Hong Kong; D006801:Humans; D038622:Internationality; D009520:New Zealand; D064406:Patient Harm / Q000517:prevention & control*; D011050:Policy Making; D003668:Pressure Ulcer / Q000517:prevention & control*; D018570:Risk Assessment; D012606:Scotland; D014481:United States
keywords: nursing; patient harm; patient safety; policy analysis; pressure injury; pressure ulcer; regulation