Development of an evidence-based pressure injury prevention care bundle for home-care settings: a systematic review and Delphi study

Pressure injury (PI) is largely preventable yet remains challenging to manage within Taiwan’s home-care system, where daily care is primarily delivered by family carers with intermittent support from visiting nurses. Existing hospital-based PI guidelines often lack contextual relevance for community environments. This study aimed to develop an evidence-based and culturally adapted PI prevention care bundle tailored to home-care practice. A three-phase modified e-Delphi process was conducted between August 2023 and August 2024. Phase 1 involved a systematic review to identify relevant evidence sources; Phase 2 comprised an expert workshop with five wound-care specialists; and Phase 3 included two rounds of e-Delphi consultation (21 experts in Round 1 and 20 in Round 2). A total of 8,999 records were identified. Of these, 110 records were screened and 73 full-text reports were assessed for eligibility, resulting in ten evidence sources (comprising eight empirical studies and two clinical guidelines). Item-level consensus was determined using predefined criteria, while Kendall’s coefficient of concordance (W), coefficient of variation (CV), and authority coefficient (Cr) were used to assess panel agreement, rating stability, and expert credibility. The final care bundle comprised five domains and 28 items adapted from the SSKIN framework. Expert agreement improved from Kendall’s W = 0.321 in Round 1 to 0.388 in Round 2 (both p < 0.001). Round 2 CV values ranged from 0.00 to 0.06, and the mean authority coefficient was 0.92, indicating stable consensus and high expert credibility. The developed care bundle provides a structured, evidence-based framework to support both nurses and family carers in delivering consistent PI prevention in home-care settings. It may also serve as a reference model for regions with similar workforce structures and community-based care systems. Further clinical validation and implementation research are required to assess effectiveness, scalability, and cross-context applicability.