• Eliminating Hospital Acquired Pressure Injuries: Prevention Bundles and Two Nurse Skin

      Snider, Victoria E.; Callender, Kimberly (2021-05)
      Problem: A Vascular Surgery Progressive Care Unit (VSPCU) in a large, academic medical center had a year-to-date hospital-acquired pressure injury (HAPI) incidence rate of 1.89 per 1000 patient days in 2019; fifty percent of these HAPI were avoidable. Purpose: The purpose of this quality improvement (QI) initiative was to eliminate HAPI incidence on a Vascular Surgery Progressive Care Unit through implementation of an evidence-based pressure injury prevention bundle (PIPB), including a two-RN skin assessment and co-sign component within 24-hours of patient admission or transfer. Methods: The Vascular Surgery Progressive Care unit consists of 12 beds and averages 53 admitted patients per month. A 16-week implementation period took place from August 31, 2020 to December 22, 2020. Head-to-toe, 2-RN skin assessment with electronic health record cosign and bundle documentation was implemented on the project unit for nurses to identify risks for HAPI, provide all admitted patients evidence-based prevention strategies, and to link staff with institutional skin prevention resources. The QI project was guided by Lippitt’s Change Theory. Staff-received project education was measured by a completion goal date. Nursing staff completed return-demonstration of 2-RN cosign and bundle note documentation within the electronic health record. Documentation of RN bundle compliance was measured by weekly chart audits. Unit HAPI incidence rates were measured by quarterly audits compiled and dispersed by the institutional Skin Integrity Committee. Data used for dissemination and discussion was comprised using run-chart analysis. Results: At Go-live 57% of RNs were PIPB trained (n = 30). A zero avoidable HAPI incidence was maintained during implementation (n = 194 patients). At week nine, 100% bundle compliance was achieved for five consecutive weeks. Conclusions: Implementation of a prevention bundle using a two-nurse skin assessment with cosign, for achieving zero unit-based HAPI is feasible and should be a care standard. Bundle compliance was associated with completed staff training, charge nurses as project champions, compliance email reminders, compliance data-sharing with staff, leadership availability and visibility, and continual team positive reinforcement.
    • Prophylactic Sacral Dressings and Skin Assessments in Acute Care Emergency Surgery Patients

      Brown, Caroline; Satyshur, Rosemarie D. (2020-05)
      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.