An Innovative Strategy to Eliminate Occipital Pressure Injuries Associated with Cardiac Surgery

Cathleen T. Van Houten, MS, RN, CNS, CWON1, Dana Chimino, BSN, RN, CNOR, RNFA2, Luba Fingerut, BSN, RN, CCRN3 and Robert Hance, MS, RN, CNOR2, (1)Adult Critical Care & Pediatric Nursing, UR Medicine/Strong Memorial Hospital, Rochester, NY, (2)Perioperative Nursing, University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY, (3)Cardiovascular Nursing, University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY
Background: Patients in the cardiovascular intensive care unit (CVICU) represent some of the most critically ill patients in the hospital. The literature supports that hypotension, anesthesia, length of surgery, increased humidity and temperature, and altered tissue perfusion and oxygenation, are among risk factors that contribute to pressure injury development.  At a Magnet-designated tertiary care hospital, more cardiac surgery patients developed occipital pressure injuries than any other service line.  Purpose: To evaluate and implement a strategy to offload occiput pressure to reduce the number of occipital pressure injuries associated with cardiac surgery.  Methods: A group of physicians and nurses met to discuss the high incidence of occipital pressure injuries. A subgroup including perioperative nurses, CVICU nurses, and a certified wound specialist nurse tested multiple options for off-loading the occiput using a pressure mapping device. Consensus regarding trial product selection was based on the following:  pressure mapping results, price, preference for a single patient use item versus a product that would need disinfection/sterilization, and agreement from all stakeholders including anesthesiology.  During the 6-month observational trial period, a single-patient use contoured memory-foam pillow was placed under every patient’s head (n=461) prior to the start of cardiac surgery and subsequently used throughout the ICU stage of hospitalization. The number of occipital pressure injuries prior to the intervention was compared to the number that occurred during the trial period.  Results: During the pre-trial period, 9 occipital pressure injuries occurred, during the trial period, 1 occipital pressure injury developed, and no additional ones have occurred since the end of the trial and continued use of the pillow.  Conclusions:  No other new prevention initiatives were implemented during the trial period; thus, it is fair to conclude that the pillow-based intervention eliminated hospital-acquired occipital pressure injuries among CVICU patients.