What the butt? Pressure injury reduction in intensive care

Background: Healthcare-acquired pressure injuries cause significant harm to over two-million patients annually in the United States, increase length of stay, and pose a significant financial burden to hospitals. The cost of treating a single injury can be more than $70,000. Local Problem: After unit expansion during the Covid-19 pandemic, and with associated acuity increase and staff turnover, healthcare-acquired pressure injuries increased 285% from 21 injuries in 2019 to 60 injuries in 2021 in Aurora Sinai Medical Center’s intensive care unit. Methods: This intensive care unit used an active multi-modal intervention approach to pinpoint contributing factors. The intervention started with “What the Butt” month, with a pressure ulcer prevention, identification, and treatment education board and competency using photos from recent unit-acquired pressure injuries. Multidisciplinary rounds included the question, “how does their butt look?” Unit leadership scheduled “Save Their Butts” wound care product in-services for shift huddles and stocked pre-assembled prone kits. The unit skin team created new turn signs indicating turn schedules. The site skin team updated the discovery audit sheet, with real-time notifications of injury discovery to a multidisciplinary drilldown team. This multidisciplinary drilldown team met monthly to perform root cause analysis of the previous month’s injuries and institute changes, with feedback emailed to staff. Nurses and respiratory therapists collaborated as accountability partners identifying high-risk patients, using newly required preventative dressings, and frequently rotating devices and masks reducing respiratory device-related pressure injuries. The respiratory therapy leadership developed a respiratory skin assessment flowsheet, now a system-wide practice change. Results/Conclusions: The healthcare acquired pressure injury rate in this intensive care unit decreased by 43% in 2022. Implications for Practice: This economical multidisciplinary, multi-modal intervention approach is effective in substantially decreasing the incidence of healthcare-acquired pressure injuries. Future studies should verify if results can be replicated