Implementation of a multimodal pressure injury bundle in neurotrauma

Abstract

Problem: An estimated $2.2 to $3.6 billion is spent annually on hospital acquired pressure injuries. In contrast, the cost of pressure injury prevention is an estimated $500 per patient. Pressure injuries are associated with increased length of stay, increased care costs, and increased complications overall resulting in a reduction of the patient’s quality of life. Cornerstones of pressure injury prevention include early identification, concise documentation, and intervention to prevent wound progression. A neurotrauma unit reported 9 hospital acquired pressure injuries in January 2022 with the sacrum as the most common location of breakdown. An increase in unit Pressure injury rates were identified in the monthly audits. Purpose: The purpose of this practice innovation is to implement a multimodal pressure injury prevention care bundle to reduce incidence of sacral pressure injury on a neurotrauma unit. Methods: The prevention bundle consisted of six components: prevention, inspection, surface offloading, risk assessment, and optimization of nutrition. The initiative was implemented over a 15-week period. All patients on the neurotrauma unit were included in project implementation. If skin breakdown was identified during inspection, an image was captured with Epic Haiku and a wound consult was placed. Wound progress was tracked through updated wound imaging to create consistent documentation practices. Weekly chart audits were used to evaluate bundle adherence, patient skin breakdown risk, and breakdown location/severity. Results: 187 patients were evaluated over a 15-week implementation period. A total of 9 hospital acquired pressure injuries were observed during the pre-implementation period (1 sacrum). 2 hospital acquired pressure injuries (2 sacrum) were observed in the post-implementation period. Bundle adherence increased from 43% (pre-implementation) to 100% (post-implementation). Unit sacral breakdown rates decreased from 9% to 0%. Overall unit hospital acquired pressure injury rate decreased from 9 per month to 0 per month. Conclusions: A multimodal bundle that incorporates wound imaging and positioning guidelines impacted in a reduction in hospital acquired pressure injury incidence..