Does a pressure ulcer bundle decrease incidence of pressure injury in an adult coronary artery bypass surgery population?

Therese Pare, BSN, RN, CWOCN, Susan DeSanto-Madeya, PhD, RN, Mary Cedorchuk, BSN, RN, Janice Cunnane, BSN, RN, CWOCN, Adam Lerner, M.D., Marjorie Serrano, MSN, RN. Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Background:  Adult coronary artery bypass surgical patients have additional identifiable risk for development of hospital acquired pressure injury (HAPI) especially during the intraoperative time frame. Specific risk factors include age greater than 60 years, gender, surgical procedure, surgery greater than 3 hours, number of comorbidities, immobility, low/high body mass index (BMI), prior pressure injury, hospital acquired pressure injury (HAPI), and type of pressure redistribution OR pad. Following the occurrence of three significant hospital acquired pressure injuries in our high risk adult coronary artery bypass surgical patients population, a team was assembled to decrease or eliminate adverse events in this high risk population.

Objective: The purpose of this study was to evaluate the effectiveness of a Pressure Injury Intervention Bundle for the adult coronary artery bypass patient population. 

Method: A quantitative retrospective nonequivalent 2 group before and after intervention design, a retrospective medical chart review of four hundred and twelve adult patients who received elective coronary artery bypass surgery, 194 from 2009 and 218 from 2012-13 were reviewed. Data was collected by the research team and entered in RedCap.

Results: The total number of pressure injuries was 15 (8%) in 2009 and 7 (3%) in 2012-2013. In 2012-2013, there was a 50% decrease in the incidence of pressure injury following the implementation of the pressure injury prevention bundle.  

Implication for Practice and Research: Our study offers suggested pressure injury prevention interventions for adult coronary artery bypass surgical patient. Although, we did not find statistically significant differences between the groups, there were meaningful differences between groups, most likely due to small sample size. Further research with a larger sample is warranted.