CSI Summary
Available only to registered AACN.org users.
Project Topic:
Decreasing hospital-acquired pressure injuries
Hospital Unit:
- Cardiothoracic Intensive Care Unit (CTU)
- 2 Cohen Step Down Unit
CSI Participants:
- Robert Goetchius, BSN, RN, CVRN
- Emma Knox, BSN, RN, CCRN
- Felicia LaPera, BSN, RN, PCCN, CVRN
- Vanessa Mauri, BSN, RN, CCRN
Project Goals/Objectives:
- Implement new processes for preoperative open-heart surgery patients
- Provide resources to staff to prevent and manage hospital-acquired pressure injuries (HAPIs)
- Identify patients with a risk for increased skin injury utilizing a skin assessment scale
- Introduce a guideline for offloading patients postoperatively
- Increase staff knowledge regarding pressure injury identification and management
- Decrease HAPIs 15%
Project Outcomes:
- Decreased HAPIs 65%
- Increased staff engagement within CTU and 2 Cohen, and with other units
- Created a stronger bond between CTU and 2 Cohen
- Improved continuity of patient care
- Increased awareness of pressure injuries among patients and hospital staff
- Increased patient and staff morale
- These outcomes resulted in a positive estimated annual fiscal impact of $323,277.
Project Overview:
The prevalence of hospital-acquired pressure injuries (HAPIs) in our units has been increasing as patient acuity continues to rise. Cardiothoracic surgery patients are at an increased risk for pressure injury development due to prolonged procedure times and complications related to hypoperfusion, tissue oxygenation, nutrition, and immobility.
HAPIs significantly increase healthcare costs, including the use of resources (dressings, support surfaces, nursing care time and medication). HAPIs also have a negative impact on the patient experience as they induce pain, increase risk of infection, reduce overall quality of life and can prolong the patient’s length of stay.
From Nov. 2022 to May 2023, there were 20 total HAPIs in CTU and 2 Cohen. Our CSI team identified HAPI reduction as the focus of our patient care improvement project. First, we assessed staff knowledge about pressure injury prevention and management using a survey, then implemented a test-of-change based on the responses. Next, we introduced a guideline for offloading patients postoperatively, including the application of a foam dressing to preoperative open heart surgery patients.
Our approach also encompassed adding easily accessible instructions for using wound care supplies to our units and educating staff on pressure injury identification and management. As a result of our project, HAPIs decreased 65% compared to the previous year’s data. These interventions also helped resolve existing pressure injuries prior to patient discharge.
The outcomes from our project have been greater than we initially anticipated. We not only achieved a lower rate of HAPIs, but we also increased staff morale and engagement from other units and created a stronger bond between CTU and 2 Cohen. Educating staff on proper pressure injury prevention has positively impacted patient outcomes and. nurses have reported feeling more confident caring for patients with varying skin concerns using the new wound care resources. In addition, the staff’s participation and accountability in recognizing the signs and symptoms of potential pressure injuries has increased.
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Disclaimer
The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.