16 A Framework for a Successful Pressure Injury Prevention Program in a Regional Burn Center

Abstract

Burn-injured patients are inherently at-risk for pressure injuries. Little evidence exists regarding pressure ulcer prevention practices for burn centers. Our verified burn center sought to decrease the incidence of hospital-acquired pressure injury (HAPI) by reducing device and positioning related pressure injuries. A key part of our plan includes education for all staff. We conducted the study at a verified regional burn center serving adult and pediatric populations. While on our journey to Magnet designation, we tracked National Database of Nursing Quality Indicators (NDNQI) data quarterly. Preliminary data indicated our rate of HAPI was above the national benchmark. We currently employ interventions such as turning every 2 hours, padding of bony prominences, use of pressure reducing or air circulating beds, proper skin care, nutritional assessment, measures that decrease length of stay, use of the Braden Scale to assess risk, and early mobilization. In addition to, we elevated some of these practices by frequent reposition of catheter securement and other invasive devices to prevent mucosal injury, elimination of supine laying in turning schedule, and improved nutritional management. The risk reduction strategy includes an improved method for securing nasogastric tubes, moisture management of wounds, standardizing heel protection, padding securement ties for endotracheal tubes, restricted use of touch fasteners on all ace bandages, regulating c-collar care, directing splint checks and addition of a stretch bandage training protocol. We collected data from monthly surveys reported to NDNQI for a total of 8 quarters. All HAPIs are reported to NDNQI specifically as the total number of HAPIs, number of patients with a HAPI, and HAPIs identified per patient. Our findings demonstrate a decrease in the overall number of HAPIs occurring in our unit since the introduction of our prevention program (p= 0.037). The number of patients with HAPIs and the number of HAPIs adjusted for unit census also dropped (p= 0.021 and p= 0.040 respectively). In addition to the decrease in the number of overall HAPIs, we have seen historically low incidence of HAPI. The burn center has experienced a dramatic decline in the incidence of hospital-acquired pressure injury due to prevention initiatives and risk reduction strategies. Burn centers should adopt programs to prevent hospital-acquired harm rather than maintain a reactive approach. Involving bedside nursing staff increases effectiveness of programs. Research is ongoing to evaluate the impact of various prevention strategies for hospital-acquired pressure injury specific to the burn population. A coalescence of practices is needed to establish industry standards of care.