Implementation of Pressure Injury Prevention Bundle in Surgical Intensive Care

Abstract

Problem: In a 10-bed adult Surgical Intensive Care Unit (SICU) at an academic medical center, seven incidents of hospital-acquired pressure injury (HAPI) were recorded from January to December of 2022. The average pressure injury intervention and documentation compliance rate was 72.27% within the first 24 hours of admission, 69.17% with ≥ 48 hours of stay, and 68.76% for the entire stay. Purpose: The aim of the quality improvement (QI) was to implement a standardized pressure injury prevention intervention bundle (PIPB) and checklist to improve staff compliance with HAPI prevention strategies and documentation. Methods: The implementation was from August to December 2023. Participants included 14 registered nurses (RNs) and two certified nursing assistants (CNAs) who completed the education and training. RNs performed the Braden Scale Risk Assessment and skin inspection/assessment for all patients in the SICU on admission, every shift, and with any significant change in condition and documented details in the Skin Inspection/Assessment Note in the electronic health record (EHR). Patients with Braden scores of ≤ 18 received bundle interventions, which were recorded in the PIPB Checklist Audit Tool. Compliance was measured weekly over 14 weeks and analyzed using a run chart. Results: Data showed a consistently high compliance rate of 96.88% (n=1028) with skin inspection/assessment and documentation over 14 weeks. The PIPB intervention and checklist compliance of 90.05% (n=543) demonstrated the effectiveness of implementing the evidence-based intervention, strategies, and tactics. Conclusion: Implementing a standardized PIPB and checklist in SICU can increase staff compliance with HAPI prevention intervention and documentation practices for accurate assessment, intervention, monitoring, and early detection of pressure injuries. Keywords: hospital-acquired pressure injury, care bundle, intensive care unit, compliance