Implementing a Pressure Injury Prevention Bundle in Cardiac Surgical Critical Care

Abstract

Problem and Purpose: In the adult Cardiac Surgery Intensive Care Unit (CSICU) of a large academic medical center the hospital acquired pressure injury (HAPI) rate is high. The average HAPI rate per 1,000 patient days for six months prior to implementation was 9.02. The hospital average for this time fame was two. Every six months this unit cares for an average of 574 patients. A literature database search revealed pressure injury prevention (PIP) bundles were an evidence-based intervention that lowered HAPI rate. The purpose of this quality improvement initiative is to implement a PIP bundle to reduce the number of HAPIs in the CSICU. Methods: Prior to implementation, strategies to prevent HAPIs were largely left up to the nurses’ discretion. A Braden Score is performed every twelve hours. All patients were to be repositioned every two hours. For the new process a score less than or equal to eighteen, patients receive; every two-hour repositioning including while in the chair, a pressure relief cushion, a multi-layer sacral dressing, heel protectors, and encouraged mobility. Staff education, a one-page education handout, unit champion, email reminders, and dissemination were used to encourage process adherence. Data was collected into a password protected HIPAA compliant server with VPN access. Results: During implementation 176 patients were admitted. 50% of these patients received the bundle. 105 admitted patients remained on the unit at 48-hours, 57% of these patients received the bundle. On admission sacral dressings, heel protectors, and 2-hour repositioning had greater than 90%compliance. Pressure relief cushion and mobility had 74% and 68% respectively. At 48-hours sacral dressing and 2-hour repositioning had greater than 98% compliance. Mobility and pressure relief cushion improved to greater than 80% usage. Conclusion: The HAPI rate during implementation was 5.26. There was a rate decrease of 3.76. No purposeful evidence of change could be determined. There was increased compliance with bundle components at 48-hours. PIP bundles are an effective standard intervention for use in the CSICU. Sustainability can be achieved using continued audits with unit champion, continued staff education, and as new HAPI prevention devices are made available the bundle can be adjusted.