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Deep tissue injury (DTI) is considered a serious reportable event. The occurrence of DTIs involves not only the injury of the patients skin, but also increases the risk of other complication, length of stay, healthcare expenses1,2, and reflects a negative perception of the quality of care.
In reviewing the data on hospital acquired pressure ulcers for 2013, 42% were noted to be DTIs identified in the cardiovascular intensive care unit (CVICU), specifically in those who had undergone a cardiothoracic surgical procedure that lasted greater than 3 hours. In an effort to reduce the number of HAPUs, a quality improvement workgroup was created to evaluate this particular patient population. The aim of the group was to decrease the occurrence of DTIs in this population by at least 10% over a 2 year period and to reduce the severity of the DTIs.
Data was collected to highlight the most critical factors leading to the development of DTIs in this population. Data collection on this population included not only pressure ulcer risk assessment scores, length of surgical procedures, and patient demographics but also nutritional status, hemodynamic factors and use of preventative strategies. Additionally surveys were conducted in the CVICU staff and OR staff to understand and capture their perception and understanding of skin risk assessment, skin assessment, prevention strategies, and hemodynamic instability. Potential inconsistent goals were uncovered in the survey results. For instance, in an effort to meet the surgical care improvement project (SCIP) measure for glucose control post operatively, patients were not being fed.
Current data results drove several initial interventions which included education, microclimate management, noncontact ultrasound, and standing delegated medical orders. Initial data trends indicate a reduction in the occurrence and the severity of DTIs in this population.