Using Evidence Based Practice Improvement to Lower the Incidence of Hospital Acquired Pressure Injuries in ICU.

Purpose: The incidence of hospital acquired pressure injuries (HAPIs) in 2017 showed a sustained increase in the intensive care unit in the institution. Out of fifty-two occurrences hospital wide, thirty-seven had occurred in the ICU. The aim of this project was to identify opportunities to improve practice, hard wire utilization of evidence based preventative interventions and to decrease HAPIs by thirty percent in first six months of 2018 as compared to first six months of 2017.

Description: An interdisciplinary team comprised of,the Wound, Ostomy and Continence (WOCN) Nurse Manager, the ICU Nurse Manager, and the Respiratory Therapy Manager to lead the reduction of the incidence of HAPIs in the ICU. A merged model of evidence based practice and performance improvement was utilized to provide the opportunity for the application of the best available evidence based interventions into the ICU practice setting. The Plan-Do-Study-Act (PDSA) model was utilized to test the implementation of the practice changes. Staff was formally educated on multiple prevention modalities: two hour turning schedules, utilizing offloading devices for heels, using turning and positioning systems with contouring pillows, five-layer prophylactic foam dressing for prevention was used for patients with Braden Scores of 18 or less on bony prominence's and the sacral area along with disposable under pads for incontinence. Encouraging early mobilization for all patients, including ventilator dependent patients was also employed. Nurse Leadership rounding occurred daily by WOC nurse and Nurse Manager, for compliance and informal education with staff.

Evaluation and Outcomes: In the first six months of 2017 prior to implementation, the incidence of HAPIs was nineteen for the ICU. After implementation, the first six months of 2018, the incidence of HAPIs was twelve, which represents a 37% decrease from 2017.