WAR ON WOUNDS:Implementation of an Individualized Robust Pressure Injury Prevention Bundle at a 400 bed Medical Center in the South West

 

Problem: A recent increase in reporting of hospital acquired pressure injuries (HAPI’s) demanded closer scrutiny regarding prevention practices, staff knowledge and documentation. Chart reviews revealed minimal documentation making it difficult to determine if the HAPIS were avoidable or unavoidable.  PI’s cause pain, distress, disfigurement, and death from complications, adding to the burden of an already financially stretched facility. Accurate documentation by the bedside RN is critical to provide a legal record of the quality of care provided and for reimbursement purposes.

Method/ Measure/ Analysis:  To gain baseline data 3 key performance metrics included:

1. Measurement of HAPI incidence & compliance using a customized chart review tool to assess for appropriate & consistent interventions
   • Results from chart reviews over 12 months revealed zero documentation compliance
2. ‘4 eyes initiative’ to improve skin surveillance at bedside
   • Initial roll out initiative resulted in not meeting target of 75% compliance
3. Assessment of staff knowledge regarding pressure injury prevention practices using tools adapted from the AHRQ PIP toolkit (2014).
   • Results revealed lack of skills and knowledge also noted by the wound care team during consults, rounding and during the NDNQI skin surveys

Intervention/Improvement:  A basic customized PIPI bundle: ‘WAR ON WOUNDS’ toolkit has been developed.  This includes charting tip sheets, tailored educational offerings and shadow experiences with WOC RNs.  A ‘skin champion WOW team’ with representatives from all units have begun to meet monthly. Team members’ function as key resources, disseminating evidence based practice peer-peer & identifying specific unit goals to improve practice within a shared governance model. 

Outcome. Interventions will be adjusted depending on ongoing evaluation to ensure practice improvements continue and are sustained resulting in fewer PI’s.  It is envisaged that documentation will be improved so that it will be easier to determine if a PI is avoidable or unavoidable.