Prophylactic Sacral Dressings and Skin Assessments in Acute Care Emergency Surgery Patients

Abstract

Problem & Purpose Statement: Hospital acquired pressure injuries (HAPIs) are a growing issue within the healthcare system. On average, 2.5 million people in the United States develop a HAPI. Annually, approximately $26.8 billion dollars is spent on treating HAPIs in the United States alone. Consequences of HAPIs include increased length of stay, decreased quality of life, increased morbidity and mortality, and decreased hospital reimbursement. The purpose of this quality improvement (QI) project is to decreased the incidence of HAPIs, in Acute Care Emergency Surgery (ACES) patients with Braden scores less than or equal to fourteen in the Surgical Intensive Care Unit (SICU) through the implementation of a prophylactic sacral dressing and nurse practitioner (NP) and registered nurse (RN) skin assessments. Methods: The QI project took place over a ten-week period, from September 2, 2019 to November 10, 2019 and was implemented in three phases. Phase I included identification of unit skin champions and education pertaining to the Braden Scale and preventing HAPIs. Phase II included the implementation of a prophylactic sacral dressing and NP & RN skin assessments. Phase III included data collection and analysis. In order to help with implementation, Lewin’s theory of planned change was utilized. Results: Prior to implementation, there was a total of six HAPIs, with Braden scores ranging from eight to fourteen, with an average of twelve. Post implementation, there were a total of zero HAPIs, with Braden scores ranging from ten to fourteen, with an average of thirteen. 96% (n=61) of ACES patients who met criteria had a prophylactic sacral dressing applied. 100% of ACES patients who met criteria had a skin assessment completed and documented by RNs, while 35% (n=22) of ACES patients who met criteria had a skin assessment completed and documented by ACES NPs. Data collection form compliance was 44% (n=35). Conclusion: Compliance rates among RNs and NPs varied in respect to the documentation, and completion of the data collection form. RNs had a higher compliance rate associated with skin assessment documentation in the electronic health record compared to NPs. There was a decrease in the incidence of HAPIs after implementation of a prophylactic sacral dressing and RN/NP skin assessments.