![[ Visit WOCN Website ]](images/banner.jpg)
Significance: HAPI prevalence rates in critically ill adults continue to remain high despite evidence-based pressure injury prevention practices and improved medical technology.1-3 HAPI contributes to multiple negative patient and organizational outcomes.4,5 While nursing practice can reduce the impact of extrinsic factors, studies are needed to examine intrinsic factors (e.g., perfusion, oxygenation) that can contribute to HAPI.
Methods: A retrospective correlational design was conducted with patients in the adult intensive care units (ICUs) at the University of Chicago Medicine. Patients were identified using quality improvement records from monthly HAPI prevalence survey days from 2014 to 2016. Any potential HAPI identified by skin care team RN was evaluated by a Certified Wound Care Nurse for confirmation. Additional data extracted via electronic medical records included patient demographics, health and care (e.g.,Braden score8) characteristics. Descriptive statistics were used to examine sample characteristics. A two sample t-test was used to examine differences between patients who did and did not develop HAPIs. Statistical significance was set at p < .001.
Results: Of the 1506 patients evaluated during monthly skin prevalence days, only 81 (5%) developed HAPIs. No differences were noted between groups by age, race, gender or Braden score at ICU admission. Patients with HAPI had: significantly longer hospital and ICU length of stays; lower MAPs; higher oxygen concentrations and fluid bolus volume; vasopressor use; lower Glascow coma, RASS and Braden scores in the 2 weeks prior to HAPI or the last ICU prevalence.
Conclusions: Both extrinsic and intrinsic factors are important targets for nursing practice to reduce HAPI. Our results provide a more comprehensive understanding about which patients are at risk and why.