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Purpose: Despite advanced technology with pressure injury prevention, there remains no one tool to provide clinicians with amount of peak pressure skin can tolerate before causing tissue injury.
Methods: Real time pressure monitors (RTPM) systems were placed on every critical care support surface for a clinical trial. Patient rounding was performed by clinical staff to obtain peak pressure prior to and after small interventions such as microshifts, foot elevation, and decreasing the head elevation by a degree. The output of the clinical trial showed a statistically significant incident decrease of Hospital Acquired Pressure Injury (HAPI) integrating the use of the RTPM with a p-value = 0.008. Before the RTPM the HAPI incidence rate was 1.03% (9/874). After the RTPM, the HAPI incidence rate was 0.11% (3/2718).However, this didn’t yield the magic number the skin can tolerate so further data exploration was required. The Lean Six Sigma department provided further analysis to determine the skin’s peak pressure prior to injury.
Results: There were 526 RTPM patient encounters when adjustments were made. The average peak pressure for pre-adjustment was 51.63, and the average peak pressure for after-adjustment was 44.37. After running a paired t-test, the adjustments resulted in peak pressure difference of 7.26, which is statistical significant with a p-value of 0.000. The 95% confidence interval shows the true, but unknown difference between pre-adjustment and after-adjustment peak pressure is between 6.88 and 7.64. There were 353 RTPM patient encounters when adjustments were not made. The average peak pressure for those patients was 38.68 with standard deviation of 4.79.
Conclusion: Understanding the skin’s tissue tolerance related to specific peak pressure point has been a difficult healthcare challenge. This research study gives us a skin assessment tool that guides interventions based on the skin’s peak pressure range of 40-45mmHg