A comparison of hospital-acquired pressure injuries in intensive care and non-intensive care units: a multifaceted quality improvement initiative

Abstract

Hospital-acquired pressure injuries (HAPI) are a significant cause of morbidity and mortality, and represent a major health concern worldwide. Patients suffering from HAPI report a poor quality of life on several dimensions of health. Moreover, HAPI is reported to lengthen in-hospital stay in the acute setting, posing significant healthcare resource utilisations and costs. Given the clinical and economic burden of HAPI, recent best practice guidelines provide recommendations to reduce the prevalence of pressure injuries. Humber River Hospital (HRH), a large community hospital in Toronto, Canada, has a daily census of approximately 500 patients. The aim of this project was to reduce the prevalence of HAPI within the intensive care unit (ICU) and non-ICU setting at HRH within a 1-year period. Using the International Pressure Injury/Ulcer Prevalence (IPUP) Survey we established a baseline prevalence of HAPI of 27.6% (n=315) for non-ICU and 30% for ICU (n=33) patients at our institution in 2015. Using the Plan-Do-Study-Act (PDSA) method for quality improvement, we implemented a multifaceted approach aimed at improving equipment, digital documentation and education on risk assessment, prevention and treatment strategies. Over multiple PDSA cycles, our prevalence of HAPI reduced to 16% for non-ICU patients with no changes to the HAPI prevalence in ICU patients in 2016. Sustainability continues with HAPI prevalence currently at 10% in 2017 for non-ICU patients, which outperforms the Canadian prevalence (13.7%) by census size for 2017. However, the prevalence of HAPI in the ICU increased to 45% in 2017 despite multiple quality improvement initiatives, suggesting critically ill patients represent a unique challenge for reducing HAPI for these patients at our institution.

Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis

“…Pressure injury (PI), also known as a pressure ulcer, was defined as “a localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear,” (p12) . PI imposes a significant economic and social burden to Australia and globally . The National Pressure Ulcer Advisory Panel, the European Pressure Advisory Panel, and the Pan Pacific Pressure Injury Alliance categorise PIs into six clinical stages (ranging from superficial to deep tissue injuries, including suspected deep tissue injury and unstageable PI); and acknowledge the increase of the negative health impacts with the depth of the PI.…”

“…PI imposes a significant economic and social burden to Australia 2 and globally. [3][4][5][6] The National Pressure Ulcer Advisory Panel, the European Pressure Advisory Panel, and the Pan Pacific Pressure Injury Alliance 1 categorise PIs into six clinical stages (ranging from superficial to deep tissue injuries, including suspected deep tissue injury and unstageable PI); and acknowledge the increase of the negative health impacts with the depth of the PI. One of the most common forms of PI are hospital acquired pressure injuries (HAPIs), defined as an area of damage to the skin/ underlying tissue that develops during an inpatient hospital stay.…”

Frequency of and risk factors for intensive care unit‐acquired sacrum pressure injuries in critically ill patients: A multicenter cross‐sectional study in China

“…Hospital‐acquired pressure injury (HAPI) is a localized injury to the skin and/or underlying tissue during an inpatient hospital stay. HAPI is a major cause of inpatient morbidity and mortality, making it an important health problem worldwide 1‐3 . Studies on HAPI have found the median incidence to be as high as 10.8% 4 .…”

Capacidade discriminativa da escala de Braden na predição de Lesão por Pressão em Unidade de Terapia Intensiva

“…Apesar do avanço tecnológico e científico, e do aperfeiçoamento dos serviços e cuidados de prevenção, a incidência de LPP se mantém alta, variando de 10,0% a 62,5%, principalmente em pacientes de unidade de terapia intensiva (UTI), sendo um dos eventos adversos do cuidado mais importantes enfrentados por gestores de saúde (Costa, et al, 2016;Campanili et al, 2015;Sousa et al, 2016;Borghardt, et al, 2015;Agência Nacional de Vigilância Sanitária [ANVISA], 2017;Alderden, et al, 2017;Goodman, et al 2015).…”