CSI Summary
Available only to registered AACN.org users.
Project Topic:
Decreasing hospital-acquired pressure injuries (HAPIs) in patients with cardiogenic shock
Hospital Unit:
- Cardiovascular Intensive Care Unit (CVICU)
- Progressive Care Unit (PCU)
CSI Participants:
- Kerry Harrison, BSN, RN, PCCN
- Alexandra Simons, BSN, RN, CCRN
- Karen Street, AAS, RN, PCCN
- Marnie Williams, AAS, RN, CCRN-CSC
Project Goals/Objectives:
- Implement multidisciplinary staff education for HAPI prevention
- Implement use of sacral foam dressings on all cardiac surgery patients
- Implement use of “Four eyes assessment” –total skin assessments by two RNs
- Educate all staff regarding electronic health record (EHR) documentation of four eyes assessments
- Decrease HAPI incidence 25%
Project Outcomes:
- Increased staff knowledge of HAPI prevention, as well as engagement and team bonding
- Decreased HAPI incidence 29%
- These outcomes resulted in a positive estimated annual fiscal impact of $108,835.
Project Overview:
The increased acuity of hospitalized patients today means that they are at higher risk for complications in the perioperative period. They may need more vasopressor support, support devices, ventilator support, nutritional intervention and prolonged immobility — all of which may lead to increased incidence of hospital-acquired pressure injuries (HAPIs). At our hospital, approximately 33% of patients in the CVICU and 8% in the PCU developed HAPIs, so our CSI team identified HAPI prevention as the focus of our project.
At a kickoff event, we began educating CVICU and PCU staff about placing a sacral foam dressing on all patients prior to cardiac surgery to help prevent HAPIs. We also provided education about the dressings to operating room (OR) nurses and technicians and them place dressings on patients, too.
In addition, our strategy included educating CVICU and PCU staff about the use of nursing “four eyes assessment” on all patients admitted to those units. Four eyes assessment involves two nurses assessing the patient’s skin for signs of breakdown and verifying placement of the sacral foam dressing to prevent HAPIs. We also educated RNs and patient care technicians about how to document the four eyes assessment in the EHR.
The CSI team created a “HAPI holiday” board that was updated monthly with the names of staff members who documented a four eyes assessment. To help encourage staff participation, we held monthly drawings for lottery scratch-off tickets, which lead to team bonding.
We presented our project at the Heart Operations Team meeting, Nursing Day of Inquiry, and St. Peters’ Skin Care Council, and to the new director for CVICU and PCU. We also shared news of our project hospital-wide in St. Peter’s publications. As a result of our team’s efforts, we decreased HAPI incidence 29% with estimated savings to the hospital of nearly $109,000 annually.
Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.
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.