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Recommended Citation
Bontz N, Emick M, Lemke M. What the Butt? Sustainable Pressure Injury Reduction in Intensive Care. Quality Improvement poster 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 poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Background
Healthcare-acquired pressure injuries (HAPI) cause harm to over two-million patients annually in the United States, increase length of stay, and pose a significant financial burden to hospitals. The cost of treating a single injury can be more than $70,000.
Local Problem
After unit expansion during the Covid-19 pandemic, HAPI increased 285% from 21 injuries in 2019 to 60 injuries in 2021 in the intensive care unit (ICU).
Method
This ICU implemented a multi-modal approach to facilitate awareness, collaboration, and accountability to HAPI reduction. The intervention started with “What the Butt?” month, site skin team reporting real-time injury discovery to a multidisciplinary drilldown team, skin champions communicating feedback to nursing staff, collaborative partnership to update medical device injury prevention, respiratory therapy leadership team developed and implemented the respiratory skin assessment flowsheet, and product updates. Sustainment of the collaborative model included continued monthly multidisciplinary drilldown meetings, communication of updated resources including the proning playbook, and creation of an annual competency on pressure injury prevention completed by all nurses and nursing assistants.
Results/Conclusions
The HAPI rate in the ICU decreased by 43% (N=35) in 2022 and then an additional 11% (N=31) in 2023. In 2024, the unit is currently on target for less than 20 HAPI for approximate 67% overall reduction since 2021 through continued collaborative efforts.
Implications for Practice
This economical multidisciplinary, multi-modal intervention approach is effective and sustainable in substantially decreasing the incidence of healthcare-acquired pressure injuries. The approach centered around awareness, collaboration, and accountability has minimal barriers to duplication and should be considered for replication in other areas or as the system standard approach to HAPI reduction.
References
Johnson, C., Giordano, N. A., Patel, L., Book, K. A., Mac, J., Viscomi, J., Em, A., Westrick, A., Koganti, M., Tanpiengco, M., Sylvester, K., & Mastro, K. A. (2022). Pressure Injury Outcomes of a Prone-Positioning Protocol in Patients With COVID and ARDS. American Journal of Critical Care, 31(1), 34–41. https://doi.org/10.4037/ajcc2022242
Padula, W. V., & Chan, K. S. (2019). The national cost of hospital‐acquired pressure injuries in the United States. International Wound Journal, 16(3), 634–640. https://doi.org/10.1111/iwj.13071
Pittman, J., Beeson, T., Dillon, J., Yang, Z., & Cuddigan, J. (2019). Hospital-Acquired Pressure Injuries in Critical and Progressive Care: Avoidable Versus Unavoidable. American Journal of Critical Care, 28(5), 338–350. https://doi.org/10.4037/ajcc2019264
Document Type
Poster
Publication Date
11-13-2024
What the Butt? Sustainable Pressure Injury Reduction in Intensive Care
Background
Healthcare-acquired pressure injuries (HAPI) cause harm to over two-million patients annually in the United States, increase length of stay, and pose a significant financial burden to hospitals. The cost of treating a single injury can be more than $70,000.
Local Problem
After unit expansion during the Covid-19 pandemic, HAPI increased 285% from 21 injuries in 2019 to 60 injuries in 2021 in the intensive care unit (ICU).
Method
This ICU implemented a multi-modal approach to facilitate awareness, collaboration, and accountability to HAPI reduction. The intervention started with “What the Butt?” month, site skin team reporting real-time injury discovery to a multidisciplinary drilldown team, skin champions communicating feedback to nursing staff, collaborative partnership to update medical device injury prevention, respiratory therapy leadership team developed and implemented the respiratory skin assessment flowsheet, and product updates. Sustainment of the collaborative model included continued monthly multidisciplinary drilldown meetings, communication of updated resources including the proning playbook, and creation of an annual competency on pressure injury prevention completed by all nurses and nursing assistants.
Results/Conclusions
The HAPI rate in the ICU decreased by 43% (N=35) in 2022 and then an additional 11% (N=31) in 2023. In 2024, the unit is currently on target for less than 20 HAPI for approximate 67% overall reduction since 2021 through continued collaborative efforts.
Implications for Practice
This economical multidisciplinary, multi-modal intervention approach is effective and sustainable in substantially decreasing the incidence of healthcare-acquired pressure injuries. The approach centered around awareness, collaboration, and accountability has minimal barriers to duplication and should be considered for replication in other areas or as the system standard approach to HAPI reduction.
References
Johnson, C., Giordano, N. A., Patel, L., Book, K. A., Mac, J., Viscomi, J., Em, A., Westrick, A., Koganti, M., Tanpiengco, M., Sylvester, K., & Mastro, K. A. (2022). Pressure Injury Outcomes of a Prone-Positioning Protocol in Patients With COVID and ARDS. American Journal of Critical Care, 31(1), 34–41. https://doi.org/10.4037/ajcc2022242
Padula, W. V., & Chan, K. S. (2019). The national cost of hospital‐acquired pressure injuries in the United States. International Wound Journal, 16(3), 634–640. https://doi.org/10.1111/iwj.13071
Pittman, J., Beeson, T., Dillon, J., Yang, Z., & Cuddigan, J. (2019). Hospital-Acquired Pressure Injuries in Critical and Progressive Care: Avoidable Versus Unavoidable. American Journal of Critical Care, 28(5), 338–350. https://doi.org/10.4037/ajcc2019264
Affiliations
Aurora Sinai Medical Center