That’s One Small Turn for Man, One Less PI for Mankind

Project Topic:

Decrease hospital-acquired pressure injuries (HAPI)

Hospital, City and State:

Methodist Hospital, San Antonio, Texas

Unit:

7 South Intensive Care Unit

CSI Participants:

• Michael Affana, BSN, RN
• Felicia Rutland, BSN, RN, CCRN

Project Goals/Objectives:

1. Decrease the number of Hospital-Acquired Pressure Injuries (HAPI) 50%
2. Implement the use of a positive air displacement device
3. Increase Healthy Work Environment Assessment Tool (HWEAT) communication and collaboration scores 5%

Project Outcomes:

1. Decreased HAPI 79%
2. Decreased HWEAT scores
3. Return on investment 6447%

Project Overview:

The prevalence of HAPIs in our units has been rising as patient acuity increases. 7South ICU patients are especially vulnerable to developing pressure injuries due to prolonged complications related to hypoperfusion, tissue oxygenation, nutrition, and immobility.

HAPIs significantly contribute to increased healthcare costs, including the use of resources such as dressings, support surfaces, nursing care time, and medication. They also negatively impact the patient experience, causing pain, raising the risk of infection, reducing quality of life, and potentially prolonging hospital stays.

Between July 2023 and December 2023, there were 29 HAPIs in the 7South ICU. The CSI team identified HAPI reduction as a priority for our patient care improvement project. We began by assessing staff knowledge on pressure injury prevention and management through a survey, then implemented a change based on the responses.

We also introduced a guideline for offloading patients' pressure points, including the use of a turning device for all patients right at admission time, except for the ambulatory ones. Our approach involved providing easily accessible instructions for using the device and respecting the turn schedule assigned at the beginning of each shift.

As a result of these interventions, HAPIs decreased by 79% compared to the previous year’s data, and existing pressure injuries were resolved before patients transfer to other floors.

The outcomes of this project exceeded our expectations. Not only did we achieve a reduction in HAPI rates, but we also boosted staff morale, increased engagement from other units, and strengthened the collaboration between staff in the 7South ICU. Educating staff on proper pressure injury prevention has had a positive impact on patient outcomes, with nurses reporting increased confidence in managing patients with various skin concerns using the new wound care resources. Furthermore, staff participation and accountability in recognizing the signs and symptoms of potential pressure injuries have significantly increased.