Purpose: Patients in critical care units are considered high risk for pressure injury (PI) development with reported rates in the United States topping 40% in some cases. Multiple factors contribute to the risk of this population including a knowledge deficit among nurses which often leads to a lack of assessment and prevention measures needed to reduce pressure injuries. This project was launched after data collected by the Wound, Ostomy and Continence Nurse (WOCN) team showed an increase in hospital acquired pressure injuries (HAPI) in the intensive care unit (ICU) in the first quarter of 2016. The rate was 11.56 per 1000 patient days. This data was collected as part of our quarterly prevalence study reported to the National Database of Nursing Quality Indicators (NDNQI). Although this rate is lower than the national average, our patients deserve process improvement to achieve 0% incidence. Participants and Setting: The setting was a 16-bed ICU at a tertiary care hospital in the Southeastern United States. Monthly data was collected over the span of a year to evaluate incidence rates of hospital acquired pressure injuries (HAPI) from Q1 2016 to Q 4 2017. Approach: The cornerstone of this project was to focus on nursing education surrounding pressure injury prevention (PIP) intervention selections. The overall goal was to heighten the quality of patient care by implementing an innovative PIP bundle that was supported by Certified Wound, Ostomy Nurse (CWON) education and knowledge sharing throughout the ICU. The Plan, Do, Study, Act (PDSA) methodology was used to monitor interventions and outcomes. Outcomes: The measurable goal of this project was to decrease the quarterly rate of hospital acquired pressure injuries in the ICU by 50% by 4Q 2017, as compared to a rate of 11.54 per 1000 patient days 1Q 2016. Subsequent quarters demonstrated incremental decreased HAPI rates of 0.9, 1.8, 1.7, 5.2, 4.3, 0.9 and 0 by 4Q 2017. This was a total reduction rate greater than 50% which was our goal. The PIP bundle highlighted by WOC nurse education resulted in significant and clinically relevant reductions in incidence of HAPI in the ICU. Our future goal is to continue with an ongoing PIP bundle and WOC nurse rounding as part of our best practice within this hospital setting. In addition, we continue to share knowledge gained by this QI project with our extended WOCN team working at our surrounding facilities.
| Published in | American Journal of Nursing Science (Volume 10, Issue 6) |
| DOI | 10.11648/j.ajns.20211006.14 |
| Page(s) | 264-269 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2021. Published by Science Publishing Group |
Pressure, Injury, Prevention, Ulcer, HAPI, PIP, NDNQI
| [1] | Anderson, M., Finch Guthrie, P., Kraft, W., Reicks, P., Skay, C., & Beal, A. (2015). Universal pressure ulcer prevention bundle with WOC nurse support. Journal of Wound, Ostomy and Continence Nursing, 3, 42, p. 217-225. doi: 10.1097/WON.0000000000000109. |
| [2] | www.npuap.org accessed Feburary 2017. |
| [3] | Cox, J., (2011). Predictors of pressure ulcers in adult critical care patients. Am Journal Critical Care, 20, 364-375. Retrieved from www.ajcc.aacnjournals.org |
| [4] | Padula, W., (2017). Effectiveness and value of prophylactic 5 layer foam sacral dressings to prevent hospital acquired pressure injuries in acute care hospitals: an observational cohort study. Journal of Wound, Ostomy and Continence Nursing, 44, 5, p. 413-419. doi: 10.1097/WON.0000000000000358. |
| [5] | Cooper, K. (December 2013). Evidence-based prevention of pressure ulcers in the intensive care unit. American Association of Critical Care Nurses. Vol. 33 No. 6. doi: http://dx.doi.org/10.4037/ccn2013985. Retrieved from www.ccnonline.org. |
| [6] | Montalvo, I., (2016). The National Database of Nursing Quality Indicators (NDNQI) OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 3, Manuscript 2. |
| [7] | Brindle, T. & Wegelin, J. (2012). Prophylactic dressing application to reduce pressure ulcer formation in cardiac surgery patients. Journal of Wound, Ostomy and Continence Nursing, 39, 2, p. 133-142. doi: 10.1097/WON.0b013e318247cb82. |
| [8] | Brindle, T., Malhotra, R., O’Rourke, S., Currie, L., Chadwik, D., Falls, P., Adams, C., Swenson, J., Tuason, D., Watson, S., & Creehan, S. (2013). Turning and repositioning the critically ill patient with hemodynamic instability. Journal of Wound, Ostomy and Continence Nursing, 40, 3, p. 254-267. doi: 10.1097/WON.0b013e318290448f. |
| [9] | Nightingale, F. (1860). Notes on nursing. New York: D. Appleton and Company. |
| [10] | Rao, A., Preston, A., Strauss, R., Stamm, R., Zalman, D. (2016). Risk factors associated with pressure ulcer formation in critically ill cardiac surgery patients. Journal of Wound, Ostomy and Continence Nursing, 43, 3, p. 242-247. doi: 10:1097/WON.0000000000000224. |
APA Style
Maria Kotula Deininger, Brenda Rutland, Gwen Lambert, Marianna Presley. (2021). The Effect of a Certified Wound Ostomy Nurse Educational Bundle on Hospital Acquired Pressure Injuries in the Intensive Care Unit: A Quality Improvement Project. American Journal of Nursing Science, 10(6), 264-269. https://doi.org/10.11648/j.ajns.20211006.14
ACS Style
Maria Kotula Deininger; Brenda Rutland; Gwen Lambert; Marianna Presley. The Effect of a Certified Wound Ostomy Nurse Educational Bundle on Hospital Acquired Pressure Injuries in the Intensive Care Unit: A Quality Improvement Project. Am. J. Nurs. Sci. 2021, 10(6), 264-269. doi: 10.11648/j.ajns.20211006.14
AMA Style
Maria Kotula Deininger, Brenda Rutland, Gwen Lambert, Marianna Presley. The Effect of a Certified Wound Ostomy Nurse Educational Bundle on Hospital Acquired Pressure Injuries in the Intensive Care Unit: A Quality Improvement Project. Am J Nurs Sci. 2021;10(6):264-269. doi: 10.11648/j.ajns.20211006.14
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Download@article{10.11648/j.ajns.20211006.14,
author = {Maria Kotula Deininger and Brenda Rutland and Gwen Lambert and Marianna Presley},
title = {The Effect of a Certified Wound Ostomy Nurse Educational Bundle on Hospital Acquired Pressure Injuries in the Intensive Care Unit: A Quality Improvement Project},
journal = {American Journal of Nursing Science},
volume = {10},
number = {6},
pages = {264-269},
doi = {10.11648/j.ajns.20211006.14},
url = {https://doi.org/10.11648/j.ajns.20211006.14},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20211006.14},
abstract = {Purpose: Patients in critical care units are considered high risk for pressure injury (PI) development with reported rates in the United States topping 40% in some cases. Multiple factors contribute to the risk of this population including a knowledge deficit among nurses which often leads to a lack of assessment and prevention measures needed to reduce pressure injuries. This project was launched after data collected by the Wound, Ostomy and Continence Nurse (WOCN) team showed an increase in hospital acquired pressure injuries (HAPI) in the intensive care unit (ICU) in the first quarter of 2016. The rate was 11.56 per 1000 patient days. This data was collected as part of our quarterly prevalence study reported to the National Database of Nursing Quality Indicators (NDNQI). Although this rate is lower than the national average, our patients deserve process improvement to achieve 0% incidence. Participants and Setting: The setting was a 16-bed ICU at a tertiary care hospital in the Southeastern United States. Monthly data was collected over the span of a year to evaluate incidence rates of hospital acquired pressure injuries (HAPI) from Q1 2016 to Q 4 2017. Approach: The cornerstone of this project was to focus on nursing education surrounding pressure injury prevention (PIP) intervention selections. The overall goal was to heighten the quality of patient care by implementing an innovative PIP bundle that was supported by Certified Wound, Ostomy Nurse (CWON) education and knowledge sharing throughout the ICU. The Plan, Do, Study, Act (PDSA) methodology was used to monitor interventions and outcomes. Outcomes: The measurable goal of this project was to decrease the quarterly rate of hospital acquired pressure injuries in the ICU by 50% by 4Q 2017, as compared to a rate of 11.54 per 1000 patient days 1Q 2016. Subsequent quarters demonstrated incremental decreased HAPI rates of 0.9, 1.8, 1.7, 5.2, 4.3, 0.9 and 0 by 4Q 2017. This was a total reduction rate greater than 50% which was our goal. The PIP bundle highlighted by WOC nurse education resulted in significant and clinically relevant reductions in incidence of HAPI in the ICU. Our future goal is to continue with an ongoing PIP bundle and WOC nurse rounding as part of our best practice within this hospital setting. In addition, we continue to share knowledge gained by this QI project with our extended WOCN team working at our surrounding facilities.},
year = {2021}
}
TY - JOUR T1 - The Effect of a Certified Wound Ostomy Nurse Educational Bundle on Hospital Acquired Pressure Injuries in the Intensive Care Unit: A Quality Improvement Project AU - Maria Kotula Deininger AU - Brenda Rutland AU - Gwen Lambert AU - Marianna Presley Y1 - 2021/12/24 PY - 2021 N1 - https://doi.org/10.11648/j.ajns.20211006.14 DO - 10.11648/j.ajns.20211006.14 T2 - American Journal of Nursing Science JF - American Journal of Nursing Science JO - American Journal of Nursing Science SP - 264 EP - 269 PB - Science Publishing Group SN - 2328-5753 UR - https://doi.org/10.11648/j.ajns.20211006.14 AB - Purpose: Patients in critical care units are considered high risk for pressure injury (PI) development with reported rates in the United States topping 40% in some cases. Multiple factors contribute to the risk of this population including a knowledge deficit among nurses which often leads to a lack of assessment and prevention measures needed to reduce pressure injuries. This project was launched after data collected by the Wound, Ostomy and Continence Nurse (WOCN) team showed an increase in hospital acquired pressure injuries (HAPI) in the intensive care unit (ICU) in the first quarter of 2016. The rate was 11.56 per 1000 patient days. This data was collected as part of our quarterly prevalence study reported to the National Database of Nursing Quality Indicators (NDNQI). Although this rate is lower than the national average, our patients deserve process improvement to achieve 0% incidence. Participants and Setting: The setting was a 16-bed ICU at a tertiary care hospital in the Southeastern United States. Monthly data was collected over the span of a year to evaluate incidence rates of hospital acquired pressure injuries (HAPI) from Q1 2016 to Q 4 2017. Approach: The cornerstone of this project was to focus on nursing education surrounding pressure injury prevention (PIP) intervention selections. The overall goal was to heighten the quality of patient care by implementing an innovative PIP bundle that was supported by Certified Wound, Ostomy Nurse (CWON) education and knowledge sharing throughout the ICU. The Plan, Do, Study, Act (PDSA) methodology was used to monitor interventions and outcomes. Outcomes: The measurable goal of this project was to decrease the quarterly rate of hospital acquired pressure injuries in the ICU by 50% by 4Q 2017, as compared to a rate of 11.54 per 1000 patient days 1Q 2016. Subsequent quarters demonstrated incremental decreased HAPI rates of 0.9, 1.8, 1.7, 5.2, 4.3, 0.9 and 0 by 4Q 2017. This was a total reduction rate greater than 50% which was our goal. The PIP bundle highlighted by WOC nurse education resulted in significant and clinically relevant reductions in incidence of HAPI in the ICU. Our future goal is to continue with an ongoing PIP bundle and WOC nurse rounding as part of our best practice within this hospital setting. In addition, we continue to share knowledge gained by this QI project with our extended WOCN team working at our surrounding facilities. VL - 10 IS - 6 ER -
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