Pressure Injury (PI) Reduction Initiative in Hemodynamically Unstable Patients

Radoslava Stoddard, BSN, RN, CWON, CFCN, Nursing Administration, SSM St Louis University Hosptial, St. Louis, MO and Gale Roxanna Lupien, MSN, RN, CNL, CWOCN, CFCN, Nursing Administration, SSM St Louis University Hospital, St. Louis, MO
Pressure Injuries (PI) are associated with increased discomfort, length of stay, cost, and mortality; annual US cost for PI care is estimated to approach $11 billion. Our previous protocol for PI prevention included: low air loss mattresses, sacral foam dressings for Braden score <18, and continuous lateral rotation therapy (CLRT) at 80-100% to achieve a 30 degree turn.  Our level 1 trauma center has 5 ICUs for complex patient needs. Hemodynamically unstable patients had difficulty tolerating aggressive CLRT and were developing sacral PIs.

To address this problem, we continued with our previous PI protocol and created a treatment algorithm for the additional use of a Patient Positioning System (PPS).  The PPS was used instead of CLRT for patients at the highest risk for PI based on evidence-based clinical criteria.  We collected and analyzed our hospital acquired PI (HAPI) data to evaluate if the use of PPS impacted our HAPI rates.  We retrospectively compared two nine month periods of HAPI in our ICU patients

Group 1: Pre-PPS intervention has 18 ICU pressure injuries (01/2014-09/2014)

Group 2: Post-PPS intervention has 8 ICU pressure injuries (12/2015-08/2016)

Hemodynamically unstable patients were able to tolerate PPS.  Both groups were similar with acuity, age, and Braden score.  The addition of PPS allowed our highest risk patients to receive effective turning and resulted in a decrease in our PI rate by over 50 percent.  Implementation of the PPS resulted in a nursing culture change facilitating decreasing HAPI and improving nursing satisfaction.