Using a Collaborative Team to Reduce Pressure Injuries Originating in the Perioperative Division (POD)

The purpose of this project is to reduce hospital acquired pressure injuries (HAPI) through an evidence-based (EB) approach.  Immobility, hypothermia, hemodynamic fluctuations, and anesthesia contribute to the incidence of surgical HAPI in the POD which may be as high as 66% (WOCN, 2017; Primiano et. al. 2011)  In July, 2014, an interprofessional Operating Room (OR) HAPI prevention workgroup was formed with the objective of reviewing  literature and identifing EB strategies to implement in the POD to reduce HAPI.  HAPI reduction strategies included: upgrading OR table surfaces, use of a 5-layer silicone foam dressings, and enhancing hand-offs to include positioning and skin integrity information as the patient moved through POD settings and inpatient areas.  Additionally, the policy for positioning surgical patients was revised to include positioning devices with the highest level of evidence supporting their use.   An emphasis was placed on staff to correctly file reports of HAPI identified in the POD to facilitate tracking and post-operative investigation. This is not a project with a defined endpoint but a continual work in progress to improve the prevention of HAPI in a large academic medical center. The overall organization percentage of HAPI, as measured in the quarterly skin surveys, has remained below 2% for the past 6 quarters. The number of reportable HAPI remained below the benchmark for the last 6 reported quarters.   Between January 2012 to June 2014 and July 2014 to December 2016, the percentage of prone pressure injuries reported through the incident reporting system decreased 19% and occipital injuries decreased 21%.  There has been a 60% reduction in the number of pressure injuries attributed to the OR identified on quarterly skin survey’s, quarter 3 of 2014 to quarter 1 of 2017.