Abstract: Unavoidable Hospital-acquired Pressure Injuries in Critical /Progressive Care (49th Annual Conference (May 19-23, 2017))

Saturday, May 20, 2017: 1:35 PM

Joy Pittman, PhD, ANP-BC, FNP-BC, CWOCN, Wound Ostomy Continence, Indiana University Health, Indianapolis, IN, Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health, Indiana University Health University Hospital, Indianapolis, IN, Janet Cuddigan, PhD, RN, CWCN, FAAN, School of Nursing, University of Nebraska, Omaha, NE and Jill Dillon, MSN, RN, CCRN, ACNS-BC, Indiana University Health, Indiana University Health Methodist Hospital, Indianapolis, IN

Healthcare organizations strive to minimize harm and provide a safe environment. Despite technological advancements, hospital acquired pressure injuries (HAPI) continue to occur. This raises the question if HAPIs may be unavoidable. The purpose of this study was to: 1) identify the proportion of HAPIs among patients in ICU/PCU that are unavoidable and 2) identify risk factors among patients that differentiate avoidable from unavoidable HAPIs.

This descriptive retrospective study examined 165 adult patients who developed a HAPI while hospitalized in ICU/PCU during 2013-2015. Using the Pressure Ulcer Prevention Inventory (a validated tool measuring implementation of risk-based interventions based on Braden subscale scores), more than 41% (67) of the HAPIs were identified as unavoidable. The majority of HAPIs were deep tissue injuries (N=102, 62%), stage 2 (N=34, 21%) and unstageable (N=25, 15%). More than 36% (60) of HAPIs were device related. Of the 47 risk factors examined, having a bowel management system was positively associated with an unavoidable HAPI (p=0.04). Length of stay (LOS) in the unavoidable group was higher (18 versus 13 days) (p= 0.057) and having a previous pressure injury approached statistical significance (P=0.09). Using logistic regression, only LOS was statistically significant. For each one day increase in LOS, the odds of developing an unavoidable HAPI increased by 3.6% (p=0.02). The number of HAPI prevention interventions in each group were statistically different with unavoidable group having more interventions implemented for the Braden subscales of Mobility (p= <0.0001), Activity (p= <0.0001), Sensory Perception (p= 0.0002), Nutrition (p= <0.0001), and Friction/Shear (p= 0.001).

The primary difference between patients with avoidable versus unavoidable HAPIs, was not the participants’ risk factors but rather the prevention interventions provided. Interventions for mobility and nutrition were consistently lacking in the avoidable group.