Reducing Unit-Acquired Pressure Injuries on a Cardiac Surgery Progressive Care Unit

Abstract

Background: Consequences of pressure injuries can be emotional and physical, including pain, body image distortion, increased risk for infection, increased length of stay in the hospital, and death. Pressure injuries create a significant economic burden for organizations and individuals. Organizations that have the highest incidences of pressure injuries receive less reimbursement for services. Local Problem: Prior to project implementation, 3 pressure injuries were found on the cardiac surgery progressive care unit during a 13-week period. The cardiac surgery progressive care unit in a large academic medical center in the mid-Atlantic region was responsible for 66% of the pressure injuries. The purpose of this quality improvement project was to implement and evaluate the effectiveness of a pressure injury prevention bundle on a cardiac surgery progressive care unit over a 13-week period using the Model for Improvement as a framework for implementation. Intervention: The pressure injury prevention bundle consisted of four steps: the Braden score, a two-nurse skin assessment on admission, a pressure-reducing surface, and a consult to the wound, ostomy, and continence nurse. Two-hundred one subjects were evaluated (n=201). The intervention was evaluated by a before-after design, comparing the number of avoidable unitacquired pressure injuries before project implementation, to after implementation of the PUPB. Results: Post-implementation, 4 pressure injuries were found on the cardiac surgery progressive care unit, but only 25% of the pressure injuries were determined to be the unit's responsibility, and 75% of the pressure injuries were determined to have occurred prior to admission to the unit. A nurse did not complete the two-nurse skin assessment on the one patient who developed a pressure injury during this project timeframe. The pressure injury was discovered 25.5 hours after admission to the unit, deeming it the cardiac surgery progressive care unit's responsibility. Conclusions: The pressure injury prevention bundle should be a standard of care for all new patient admissions. When all of these factors are used together in a bundle, this project demonstrates that the unit could have zero unit-acquired pressure injuries.