Specialty specific intervention bundle for the prevention of pressure injuries in ICU.

Abstract

Background. Patients in the intensive care unit (ICU) are at high risk of developing pressure injuries. Recognising that existing approaches to their management were fragmented and sub-optimal, we developed an ICU-specific, multi-intervention bundle to minimise their incidence and severity. Methods. We reviewed cases of Stage 3 and 4 pressure injury to ascertain their cause and identify interventions appropriate for ICU patients with multiple pressure injury risk areas. We identified barriers to rapid access to appropriate dressings and equipment in the unit and deficits in staff’s knowledge of their best use. A multi-intervention bundle targeting these issues was developed and implemented in May 2017. Results. The intervention comprised: (1) standardisation of all dressings and equipment; (2) their storage within a centralised pressure injury prevention trolley; (3) staff education delivered during huddles; and (4) display of pressure injury risk and prevention posters within the unit. Patient assessment was via the Braden Scale. Retrospective analysis of incident reports (RISKMAN) in the year prior to and following implementation suggested a reduction in pressure injuries (May 2016-May 2017-Stage1=19; Stage2=5; Stage3/4=2 compared to June 2017-April 2018- Stage1=7; Stage2=7; Stage3/4=0). Discussion. Hospital-acquired pressure injuries are associated with pain, infection risk, prolonged length of stay, higher costs, and are preventable. We developed a specialty-specific bundle based on generic underlying principles of pressure injury prevention. It appears to have improved staff engagement and patient outcomes with the potential for reduction in costs associated with inappropriate use of dressings.