Abstract
Background: Hospital Acquired Pressure Injuries (HAPIs) result in harm that impacts patients, families, and care givers. The physical, emotional, and financial burden is significant, costing $9.1 -$11.6 billion annually. We had previously reported that > 60% of pediatric pressure injuries at our organization were associated with medical devices (Visscher et al 2015). Despite having decreased our overall rate of serious harm HAPIs by 50% in FY’18, our rate of stage II’s had increased to a rate of 1.17 per 1000 patient days. In FY’18, 78% of our pressure injuries were associated with devices with the top categories being Respiratory Care device related injuries. Objectives: To decrease the overall rate of stage 2 pressure injuries per 1,000 patient days from 1.17 to 0.77 by July 31, 2019. Methods: Utilizing the model for improvement, we determined smart aims, developed a key driver diagram, mapped failure modes, and tested interventions using PDSA cycles. Interdisciplinary sub-teams were formed consisting of RNs and RRTs from critical care and medical-surgical units. The teams focused on respiratory devices, EEG leads, tubing, and staff education and coaching to reduce pressure injuries. Using multiple PDSA cycles, teams focused on the following interventions: RNs and RRT skin champions conducted multidisciplinary skin rounds, Frontline teams used daily and weekly pressure injury data to identify trends and practices that needed coaching. Learning was shared organically across unit boundaries. Skin champions and wound teams actively coached at the bedside to empower front line staff to identify barriers to care and mitigation strategies. Skin champions engaged patients and families during rounds. Results: A 48% reduction in stage II pressure injuries from 0.96 to 0.5 per 1,000 patient days was achieved in Q2. For the same time period, we achieved an 81% reduction in serious pressure injuries (stage 3, 4, and unstageable) from 0.16 to 0.03 per 1,000 patient days Conclusions: Interdisciplinary collaboration across the system with an intentional focus, utilization of the model of improvement, and application of a differentiated practice model resulted in significantly reduced serious harm and stage II pressure injuries. An unexpected outcome was that by focusing on our stage II pressure injuries, we significantly decreased our serious harm pressure injuries to a rate of 0.03 per 1,000 patient days.
Footnotes
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