An Evidence Based Initiative: Decreasing Pressure Injury Incidence Rate re: Pronation in Critical Care

An evidence based program was initiated in a critical care service line to decrease the incidence of pressure injuries that were occurring in patients being proned.  The ACE Star Model of Knowledge Transformation was used as the conceptual framework for the initiative. Although pressure injury rates were low in the critical care service units (0.8), 25% of pressure injuries that did occur were in proned patients. A root cause analysis identified that skin care prevention measures were not standardized for proned patients. Literature review and analysis was done using Cochrane, Pub Med and CINAHL; clinical practice guidelines were also reviewed.  Based on the evidence, a checklist was developed that identified specific protocols for pre proning therapy and while patient was in both supine and prone positions.  A pronation preparation kit was also developed so that staff would have all items on the checklist needed when initiating prone therapy. Education was provided to all staff prior to integration of the checklist into practice. Pre data revealed that 4 of 4 patient’s proned developed pressure injuries. Post integration of the evidence based practice changes resulted in prevention of proned patients developing pressure injuries:  3 patients were proned with no patients developing pressure injuries. Standardizing skin prevention measures through utilization of a checklist approach to maintain skin integrity in critical care proned patients resulted in eliminating pressure injuries in this patient population.