The Effect of a Certified Wound Ostomy Nurse Educational Bundle on Hospital Acquired Pressure Injuries in the Intensive Care Unit: A Quality Improvement Project

Abstract

<i>Purpose:</i> Patients in critical care units are considered high risk for pressure injury (PI) development with reported rates in the United States topping 40% in some cases. Multiple factors contribute to the risk of this population including a knowledge deficit among nurses which often leads to a lack of assessment and prevention measures needed to reduce pressure injuries. This project was launched after data collected by the Wound, Ostomy and Continence Nurse (WOCN) team showed an increase in hospital acquired pressure injuries (HAPI) in the intensive care unit (ICU) in the first quarter of 2016. The rate was 11.56 per 1000 patient days. This data was collected as part of our quarterly prevalence study reported to the National Database of Nursing Quality Indicators (NDNQI). Although this rate is lower than the national average, our patients deserve process improvement to achieve 0% incidence. <i>Participants and Setting:</i> The setting was a 16-bed ICU at a tertiary care hospital in the Southeastern United States. Monthly data was collected over the span of a year to evaluate incidence rates of hospital acquired pressure injuries (HAPI) from Q1 2016 to Q 4 2017. <i>Approach:</i> The cornerstone of this project was to focus on nursing education surrounding pressure injury prevention (PIP) intervention selections. The overall goal was to heighten the quality of patient care by implementing an innovative PIP bundle that was supported by Certified Wound, Ostomy Nurse (CWON) education and knowledge sharing throughout the ICU. The Plan, Do, Study, Act (PDSA) methodology was used to monitor interventions and outcomes. <i>Outcomes:</i> The measurable goal of this project was to decrease the quarterly rate of hospital acquired pressure injuries in the ICU by 50% by 4Q 2017, as compared to a rate of 11.54 per 1000 patient days 1Q 2016. Subsequent quarters demonstrated incremental decreased HAPI rates of 0.9, 1.8, 1.7, 5.2, 4.3, 0.9 and 0 by 4Q 2017. This was a total reduction rate greater than 50% which was our goal. The PIP bundle highlighted by WOC nurse education resulted in significant and clinically relevant reductions in incidence of HAPI in the ICU. Our future goal is to continue with an ongoing PIP bundle and WOC nurse rounding as part of our best practice within this hospital setting. In addition, we continue to share knowledge gained by this QI project with our extended WOCN team working at our surrounding facilities.