Reduction of Hospital Acquired Pressure Injuries in ICU patients through daily skin rounds

Description of the problem:  The incidence and prevalence of hospital-acquired pressure injuries tend to be higher among critically-ill patients in the ICU setting, resulting in prolonged hospitalization and readmissions, increased risk of infection, need for surgical interventions, and increased morbidity and mortality.  Patients in the ICU setting may experience decreased mobility, poor tissue perfusion, compromised nutritional status, and hemodynamic instability, all of which contribute to an increased risk of pressure injury development. Intrinsic factors contributing to pressure injury development include older age, immobility, paralysis, diabetes, spinal cord injury, renal insufficiency, multi-organ failure, and cardiovascular disease. External factors include administration of norepinephrine and/or dopamine, sedation, incontinence, moist skin, mechanical ventilation, hemodialysis, veno-venous hemofiltration (Tayyib, Coyer & Lewis, 2013). Baseline Data and Methodology:  In an effort to decrease the rate of hospital-acquired pressure injuries in the ICU settings, daily skin rounds were initiated in October 2012.  At the start of daily ICU rounds, the hospital-acquired pressure injury prevalence rate in the ICU setting was 6.3%.  The daily skin rounds team comprised of a certified wound ostomy continence nurse (CWOCN), the clinical nurse specialist (CNS) for the unit and/or nurse educator, and the registered nurse (RN) for the patient being assessed.  Each ICU patient in the hospital received a head-to-toe skin assessment by the skin rounds team each morning from Monday to Friday.  Pressure injury prevalence data for the entire hospital is gathered monthly, on the 3^rd Thursday of every month.  A head-to-toe skin assessment is completed for every patient in the hospital on that day.  Results:  When the ICU skin rounds began in October 2012, the HAPI prevalence rate for the ICUs was 6.4%.  After five consistent years of daily skin rounds in the ICUs, the HAPI prevalence rate decreased to 2.5% by September 2017, lowering our HAPI prevalence rate by 61.0%.