Don’t Fold Under Pressure

Methodist Hospital-Metropolitan (San Antonio, Texas)

CSI Presentation

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Project Topic:

Hospital Acquired Pressure Injury (HAPI)

Hospital Units:

  • Medical Intensive Care Unit (MICU)
  • Surgical Intensive Care Unit (SICU)

CSI Participants:

  • Anthony Booth, BSN, RN
  • Irene de Jesus, BSN, RN
  • Edgar Diaz, RN
  • Maricela Garcia, BSN, RN
  • Saudy Kanu, BSN, RN
  • Mallory Meehan, BSN, RN
  • Allison Pittius, BSN, RN, CCRN

Project Goals/Objectives:

  1. To improve Pressure Ulcer Knowledge Test (PUKT) scores 15%
  2. To improve PI prevention practices by achieving 80% “Green cards” out of the total Kamishibai Cards (K-Cards).
  3. Reduce HAPIs 20%.

Project Outcomes:

  1. Achieved 12%increase in PUKT scores in both SICU and MICU
  2. Achieved 39% increase in MICU K-Cards and 46% increase in SICU K-Cards.
  3. Reduced hospital acquired pressure injury (HAPI) 61% in SICU and 18% in MICU

Project Overview:

In 2020, the MICU and SICU were challenged with the COVID-19 pandemic and the loss of a significant number of experienced nurses to travel nursing assignments. In addition to the acute rise in nurse turnover and in patient’s acuity, the units’ hospital acquired pressure injury (HAPI) rates increased. In 2020, a total of 92 HAPIs (53 of which are unit-acquired) were identified in the MICU and SICU.

The CSI team developed education for staff and evidence-based guidelines for the prevention and management of HAPIs. The team distributed the Pressure Ulcer Knowledge Test (PUKT), a valid and reliable tool, and analyzed the scores before and after education.

To measure the impact of the evidence-based guidelines on nurses’ practice, the team adopted the Kamishibai cards (K-cards) lean concept and developed a bedside audit tool. A Green K-card indicates that all of the bundle elements (10 in supine and 17 in prone) were satisfied. If one or more bundle elements is not compliant, a red K-card is generated. The percentage of green K-cards was compared before and after implementation.

The team performed weekly prevalence rounds on all MICU and SICU patients to measure the impact of these guidelines on patients’ outcomes. The number of HAPI and unit-acquired pressure injuries were compared pre and post-implementation of the guidelines.

The PUKT average score in both units improved by 12%. The team found that 76% of bedside audits were in 100% compliance (green K-cards), which is close to the 80% set goal. The number of pressure injuries in both units combined decreased from 45 to 25, a 44% improvement that surpassed the goal set. This decrease in number of HAPI reflects a $290,120 cost savings after project implementation and a projected annual saving of $1,392,576.

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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.

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.