Abstract: Bundling for Change: Implementing Pressure Injury Prevention (49th Annual Conference (May 19-23, 2017))

Meredith Cooper, BSN, CCRN, ICU, Baton Rouge General Medical Center, Baton Rouge, LA, John Godke, MD, FACCP, LSU- Baton Rouge Section of Pulmonary and Critical Care Medicine, Baton Rouge, LA and Jobe Nasca, RN, BSNc, Intensive Care Unit, Baton Rouge General Medical Center, Baton Rouge, LA

Introduction:

Our 24 bed medical-surgical critical care unit observed a sharp increase in hospital acquired pressure injury (HAPI) incidence rates from 4.52 per 1000 patient days (2014 - 2015) to 13.58 per 1000 patient days (February - May 2016). This culminated in a total of 35 HAPI, 26 of which were Deep Tissue Injuries (DTI). A significant problem with support surfaces was changed immediately. A multidisciplinary team utilized the Plan, Do, Study, Act cycle to implement a prevention bundle and test of change.

Summary of Interventions:

Bundle interventions included a five layer soft silicone border sacral dressing, offloading heel boots, and an air displacement positioning system with fluidized positioner. After literature review, at risk patients identified included: patients with expected ICU LOS >72hrs, BMI >40 or <19, vasopressor or paralytic use, any pressure injury (PI) present on admission or history of PI, Braden <13, or RASS >+2.

The preventive 5-layer sacral dressing, left in place for up to seven days unless soiled, was implemented over the first month. Next, positioning with a foam wedge or pillow was changed to positioning with an air displacement positioning system with fluidized positioner. Staff were educated on all shifts. Each discipline evaluated the new system. Skin and risk assessments every twelve hours continued throughout the project.

Results:

All patients receiving the complete bundle were pressure injury free. Three patients in cardiogenic shock who did not receive the complete bundle developed pressure injuries during the project.

The total cost of the bundle per patient including (2) heel boots, (1) positioning system and (1) sacral dressing was $242.18. In comparison, the treatment cost of hospital acquired, Stage II pressure injury is estimated up to $10,000. The preventative cost for forty-one ICU patients is roughly equivalent to the cost of treating a single Stage II HAPI.