Under Pressure: Reducing Hospital-Acquired Pressure Ulcers in the MICU

Brigham and Women’s Hospital (Boston, Massachusetts)

CSI Summary

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CSI Presentation

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Project Topic

Pressure ulcer prevention

CSI Participants

Beth Melanson, RN, MSN, CCRN
Meg Nemitz, RN, BSN, CCRN
Katie O'Connell, RN, BSN
Kim Pritchard, RN, CCRN

Project Goals/Objectives

  1. To reduce hospital-acquired pressure ulcer (HAPU) prevalence in the MICU 40 to 50 percent
  2. To provide pressure ulcer prevention and practice change education to 80 percent of nursing and Patient Care Assistant (PCA) staff
  3. To increase adherence to pressure ulcer bundle components
Project Outcomes
  1. Decreased the HAPU prevalence rate reported to Massachusetts Patient Care Link from 33.3 percent in March 2013 to 10.5 percent in December 2013 (68 percent reduction)
  2. Decreased HAPUs by five in the 19 weeks post educational intervention, for a projected annual fiscal impact of $590,884
  3. Decreased sacral/coccyx/gluteal cleft HAPUs by five in eight weeks as a result of the Mepilex border sacrum trial, for a projected annual fiscal impact of $1,403,350
  4. Achieved 100 percent attendance of staff during three education days (84 percent overall of permanent MICU staff and several float RNs)
  5. Increased average off-loading during 24 hours from seven times prior to staff education to eight times post education (less than target of 10 times)
  6. Average 60 percent adherence to the "four eyes on admission" process
  7. These outcomes resulted in a combined projected annual fiscal impact of $1,994,234.

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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.