The Effect of WOC Nurse Educational Interventions on Hospital Acquired Pressure Injuries in ICU

Critical care patients are among some of the highest risk for developing pressure injuries with reported rates in the United States ranging from 14-42%. (1) Multiple factors contribute to the risk of this population including a knowledge deficit among nurses which often leads to a lack of assessment, prevention and treatment of pressure injuries. This project was launched after data collection by the WOC team showed an increase in hospital acquired pressure injuries in the medical intensive care unit (MICU) in the first quarter of 2016. The setting was a sixteen bed MICU in a tertiary care facility in the Southeastern United States.  Monthly data was collected over the span of a year to evaluated incidence rates of HAPI from Q1 2016 to Q1 2017.

The Plan, Do, Study, Act (PDSA) methodology was used to monitor interventions and outcomes. While the outcome indicator of HAPI rates were monitored, the success of the project was determined within the measurement of the process indicators such as skin assessment, turning, early mobility, preventative dressings, use of positioning devices and moisture management. The cornerstone of this bundle project was the presence of the WOC nurse during interdisciplinary rounding. In addition, collaboration between the WOC nurse, unit educator, and nurse manager provided ongoing approaches to quick concise educational opportunities to keep pressure injury prevention on the forefront.

The incidence rates Q1 2016 were 11.56 HAPI per 1000 patient days. Subsequent quarters demonstrated incremental decreased rates of 0.9, 1.8, 1.7,5.2 with a total reduction rate of 55%.

The PIP bundle highlighted by WOC nurse education resulted in significant and clinically relevant reductions in incidence of HAPI in the MICU.