WAR ON WOUNDS: Implementation of a Pressure Injury Prevention Bundle at a 400 Bed Medical Center in the Southwest: Phase 2: Impact

Background/Problem:

A recent increase in hospital acquired pressure injuries (HAPIs), inconsistent practices and poor documentation led to the development and implementation of our pressure Injury prevention bundle (PIPB) during the beginning of 2018 . This coincided with a significant HAPI increase especially in the ICU possibly related to an increased staff awareness regarding performing more thorough skin assessments and promptly reporting HAPIs. It became evident that the problem was bigger than anticipated. Improvement projects involving our quality department were initiated between leadership and unit staff, to set goals and to organize key data to track and report progress.

Interventions

Our PIPB includes best practice tip sheets, turning clocks, new hire/grad presentations, shadow experiences, changes in the electronic record, development of a skin champion team and customizing the bundle to the needs of the unit e.g. The ICU PIPB now includes the WOCRN attending multi-disciplinary rounds to improve team collaboration.

Methodology to Determine Improvements

4 key measures include:

• Tracking facility and unit HAPI rates & sharing data with all staff
• Chart reviews of each HAPI to determine if documentation included specific interventions
• Analysis & dissemination of NDNQI quarterly survey results
• ‘4 eyes’ 2 RN skin assessments on admission

Results

Although we are not seeing a facility wide HAPI reduction yet, there have been notable improvements within departments including the ICU. Within these areas our data reveals a reduction of HAPIs, more consistent documentation and we are exceeding the ‘4 eyes’ target.

Conclusion

As we continue to implement our PIPB it is important not to become discouraged when progress appears slow. It is important to celebrate improvements achieved within our units and identify specific practices and staff who are achieving positive outcomes. This is vital to creating and sustaining the culture required to prioritize and improve practice regarding pressure injury prevention.