Strategies to Sustain Pressure Injury Prevention in Cardiothoracic Intensive Care Unit: A Quality Improvement Project

Purpose: The prevention of hospital acquired pressure injury (HAPI) has been an ongoing challenge for Cardiothoracic Intensive Care Unit (CTICU). Those patients are considered the most at-risk patient populations developing PI due to their hemodynamic instability, requirement of vasopressor, cardiopulmonary bypass for respiratory and circulatory support. The prevalence of HAPI was above the national benchmark in 2014 and 2015.  A nurse-led multidisciplinary quality improvement project for prevention of HAPI was initiated in 2^nd quarter of 2015. The purpose was to assess the effectiveness of the HAPI prevention program with a goal to reduce HAPI in 2016 by 50%.

Methods: The quality improvement task force discussed the current PI prevention strategies and identified areas for improvement.  The prevention program consisted of 2 phases with aims for early identification of risk factors and early implementation of interventions to mitigate the risk of developing HAPI. The first phase was rolled out in the 2^nd quarter of 2015. The strategic components consisted of re-education of all staff in both CTICU and Perioperative unit on risk assessment, PI prevention, standard use of a fluidized positioning and positive air displacement system on all CT post-operative bed for safe patient handling and transfer, and use of high-density foam chair cushions as offloading seating surface.  The second phase was mapped out in 4^th quarter of 2015.  It involved reinforcing PI prevention education for CTICU and perioperative staff, as well as prophylactic use of adhesive silicone foam dressings for all pre-operative CT patients. 

Outcomes/conclusions: The prevalence of HAPI was decreased from 16% (2014) to 11.6% (2015), and declined to 0% in 2016. The QI task force attributed that a comprehensive, proactive, and collaborative team approach for preventing HAPI played a pivotal role for improving patient outcomes in the CTICU.