Wound Team Clinical Skin Rounding in the Intensive Care Unit to Decrease Hospital Acquired Pressure Injury Rates

Abstract

Hospital Acquired Pressure Injuries (HAPI) reflects upon nursing care effectiveness and is seen as a nursing quality outcome measure. HAPIs are a global concern due to many factors and contribute to an increase in treatment costs, increase length of stay, possible litigation, and reimbursement issues. HAPIs are seen as a preventable adverse event as identified by Centers for Medicare and Medicaid services (CMS). Data gathered before initiation of this project indicated that within a 12-month period both the MICU and SICU demonstrated a HAPI rate of 47% of the total HAPI occurrences in the hospital. Goal Statement: Among intensive care patients would daily clinical skin assessment rounding, done with a wound nurse expert and bedside nurse, versus current standard practice, decrease Hospital Acquired Pressure Injuries rates? Utilizing the Evidence-Based Practice Institute Conceptual Model, as well as the United States National Pressure Ulcer Advisory Panel Staging System as a guide for this project, the certified wound expert rounded on each patient with the assigned critical care nurse and made focused Head-to-Toe assessments. Informal teaching by the wound expert was provided at the bedside with instruction on pressure relieving interventions, HAPI risk factors, and proper identifiable staging. Assessment of 450 patients demonstrated no identified stage II or greater HAPIs and a clinically relevant reduction in the incidence of pressure injuries during the project period. Benefits to patients included improved skin surveillance and early HAPI detection. An educational focus on Medical-Device Related HAPIs should be considered in future projects.