Implementation of an Algorithm to Prevent Pressure Injuries Among Immobile Residents

Abstract

Problem: Pressure injuries (PI) stages II, III, and IV became a serious health problem at a long-term care (LTC) facility in Maryland during the unprecedented times of the Coronavirus 2019 (COVID-19) pandemic. The executive director reported that several immobile residents in each of the facility’s (n=12) three units developed PIs: seven sacral ulcers, stages II, III, and IV; five heels, consisting of two right outers; and three left outers, stages II and III. In addition, (n=2) PIs stage III became infected. Purpose: The purpose of this quality improvement (QI) project was to implement a PI algorithm for prevention and expeditious intervention for PIs. Methods: The QI project was implemented August-December 2021. Pre-implementation, in person, the DNP student educated change champions, registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs)/geriatric nursing assistants (GNAs), on the algorithm. After the education session, a copy of the algorithm was laminated and posted at each nursing station in the three units. Additional strategies included training CNAs/GNAs on adhering to the turning schedule and filling out the log posted in each resident's room. In addition, each nursing staff member completed a pretest, then viewed an educational PowerPoint, and completed a post-test to evaluate knowledge of PIs. During implementation, the DNP student tracked structure, process, and outcome measures weekly through chart audits and PI prevention rounding audit tool. Results: A pie chart displayed structure measures; 80% (n=20) of nursing staff were trained on the algorithm. Zero new PIs stages II, III, and IV were reported during implementation of the algorithm. Sacral PIs stages II (n=7) improved. At week ten, 100% algorithm compliance was achieved; additionally, 90% was achieved at weeks twelve and thirteen. Conclusion: Implementation of the PI algorithm at the LTC facility during COVID-19 effectively improved residents' quality of life, prevented PIs, and decreased morbidity and mortality. Continuing education and training will be needed to maintain sustainability.