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Recommended Citation
White J, Dulaney M. Pressure Off: A phased-intervention approach to decreasing Unit-Acquired Pressure Injuries on a Medical-Surgical Telemetry Unit. Quality Improvement podium presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Quality Improvement podium presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Background
The AHRQ stated that a Hospital-Acquired Pressure Injury (HAPI) has a significant fiscal impact. A HAPI decreases functional level, leading to further complications with longer hospital stays and increased risk of mortality. The 10A medical-surgical telemetry unit had six HAPIs in 2023 and two HAPIs in 2024. In 2023, the unit’s two-person Skin Assessment compliance was 53.38%. A January 2024 audit revealed only 21% of patients were turned per the unit’s goal of a total of six or more repositioning occurrences per shift.
Aim/Purpose
Reduce the number of HAPIs by 50% in 2024, increase the occurrence and documentation of two-person skin assessments, and increase the percentage of turns performed every two hours by 30% in three months.
Implementation
Using the IOWA model, an educational needs assessment analyzed current knowledge and identified barriers in HAPI prevention. Patient education on HAPI prevention using existing education in the EHR was initiated on March 11th. Staff education was led by the Clinical Nurse Leader and Unit Educator March 14th-28th. A post-assessment was administered assessing the educational interventions' effectiveness in April and will be administered again in August. A standard approach for skin assessment was started on March 25th, which included an admission kit and real-time documentation coaching. Lastly, on April 1st an alarm was initiated to send turn reminders to staff.
Outcome Measures
The t-test results of the pre- and post- educational assessment demonstrated a statistical significance (p-value = 0.004). Documentation of turns has improved from 21% in January to 48% as of May 2024. No additional HAPIs have occurred, and two-person Skin Assessments have increased to 96%.
Implication for Practice
Educational intervention and implementing a standard process is essential to improve compliance with skin assessment and turning protocol to decrease risk of HAPI.
References
Alderden, J., Cummins, M., Drake, K., Yap, TL., Zaratkiewicz, S., & Zhao, Lucy Yunchuan. Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted with Community-Acquired Pressure Injury: A Retrospective Cohort Study. J Wound Ostomy Continence Nurse. 2020; 47(5):470-476. Doi:10.1097/WON.0000000000000691
Callender, LF., Johnson, AL., & Pignataro, RM. Patient-Centered Education in Wound Management: Improving Outcomes and Adherence. ADV Skin WOUND CARE. 2021; 34:403-410. Doi: 10.1097/01.AWS.0000753256.29578.6c
Chaboyer, W., Deakin, J., Gillespie, B., & Nieuwenhover, P. An education intervention care bundle to improve hospitalised patient’s pressure injury prevention: A before and after study. Wound Practice and Research. 2020; 28(4):154-162. Doi: https://doi.org/10.33235/wpr.28.4.154-162
Cox, J., Edsberg, LE., Klooms, K., & VanGlider-Freese, CA. Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey. J Wound Ostomy Nurs. 2022;49(3):211-219. Doi:10.1097/WON.0000000000000878
Edwards, P, Pfeifer, L, Tomlinson, C. Preventing hospital-acquired pressure injuries. American Nurse Journal. 2024; 19(1). Doi:10.51256/ANJ012406
The Joint Commission. Quick Safety 25: Preventing pressure injuries. March 2022. https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-issue-25-preventing- pressure-injuries/preventing-pressure-injuries/
Document Type
Oral/Podium Presentation
Publication Date
11-13-2024
Pressure Off: A phased-intervention approach to decreasing Unit-Acquired Pressure Injuries on a Medical-Surgical Telemetry Unit
Background
The AHRQ stated that a Hospital-Acquired Pressure Injury (HAPI) has a significant fiscal impact. A HAPI decreases functional level, leading to further complications with longer hospital stays and increased risk of mortality. The 10A medical-surgical telemetry unit had six HAPIs in 2023 and two HAPIs in 2024. In 2023, the unit’s two-person Skin Assessment compliance was 53.38%. A January 2024 audit revealed only 21% of patients were turned per the unit’s goal of a total of six or more repositioning occurrences per shift.
Aim/Purpose
Reduce the number of HAPIs by 50% in 2024, increase the occurrence and documentation of two-person skin assessments, and increase the percentage of turns performed every two hours by 30% in three months.
Implementation
Using the IOWA model, an educational needs assessment analyzed current knowledge and identified barriers in HAPI prevention. Patient education on HAPI prevention using existing education in the EHR was initiated on March 11th. Staff education was led by the Clinical Nurse Leader and Unit Educator March 14th-28th. A post-assessment was administered assessing the educational interventions' effectiveness in April and will be administered again in August. A standard approach for skin assessment was started on March 25th, which included an admission kit and real-time documentation coaching. Lastly, on April 1st an alarm was initiated to send turn reminders to staff.
Outcome Measures
The t-test results of the pre- and post- educational assessment demonstrated a statistical significance (p-value = 0.004). Documentation of turns has improved from 21% in January to 48% as of May 2024. No additional HAPIs have occurred, and two-person Skin Assessments have increased to 96%.
Implication for Practice
Educational intervention and implementing a standard process is essential to improve compliance with skin assessment and turning protocol to decrease risk of HAPI.
References
Alderden, J., Cummins, M., Drake, K., Yap, TL., Zaratkiewicz, S., & Zhao, Lucy Yunchuan. Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted with Community-Acquired Pressure Injury: A Retrospective Cohort Study. J Wound Ostomy Continence Nurse. 2020; 47(5):470-476. Doi:10.1097/WON.0000000000000691
Callender, LF., Johnson, AL., & Pignataro, RM. Patient-Centered Education in Wound Management: Improving Outcomes and Adherence. ADV Skin WOUND CARE. 2021; 34:403-410. Doi: 10.1097/01.AWS.0000753256.29578.6c
Chaboyer, W., Deakin, J., Gillespie, B., & Nieuwenhover, P. An education intervention care bundle to improve hospitalised patient’s pressure injury prevention: A before and after study. Wound Practice and Research. 2020; 28(4):154-162. Doi: https://doi.org/10.33235/wpr.28.4.154-162
Cox, J., Edsberg, LE., Klooms, K., & VanGlider-Freese, CA. Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey. J Wound Ostomy Nurs. 2022;49(3):211-219. Doi:10.1097/WON.0000000000000878
Edwards, P, Pfeifer, L, Tomlinson, C. Preventing hospital-acquired pressure injuries. American Nurse Journal. 2024; 19(1). Doi:10.51256/ANJ012406
The Joint Commission. Quick Safety 25: Preventing pressure injuries. March 2022. https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-issue-25-preventing- pressure-injuries/preventing-pressure-injuries/
Affiliations
Carolinas Medical Center