Using Pressure Mapping to Optimize Hospital-Acquired Pressure Injury Prevention Strategies in the Burn Intensive Care Unit

Abstract

Although prior studies have demonstrated the utility of real-time pressure mapping devices in preventing pressure ulcers, there has been little investigation of their efficacy in burn intensive care unit (BICU) patients, who are at especially high risk for these hospital-acquired injuries. This study retrospectively reviewed clinical records of BICU patients to investigate the utility of pressure mapping data in determining the incidence, predictors and associated costs of hospital-acquired pressure injuries. Of 122 patients, 57 (47%) were studied prior to implementation of pressure mapping and 65 (53%) were studied after implementation. The hospital-acquired pressure injury rate was 18% prior to implementation of pressure monitoring, which declined to 8% post-implementation (chi square: p=0.10). Hospital acquired pressure injuries were less likely to be stage 3 or worse in the post-implementation cohort (p<0.0001). Upon multivariable-adjusted regression accounting for known predictors of hospital-acquired pressure injuries in burn patients, having had at least 12 hours of sustained pressure loading in one area significantly increased odds of developing a pressure injury in that area (odds ratio 1.3, 95%CI 1.0-1.5, p=0.04). Patients who developed hospital-acquired pressure injuries were significantly more likely to have had unsuccessful repositioning efforts in comparison to those who did not (p=0.02). Finally, implementation of pressure mapping resulted in significant cost savings - $6,750 (standard deviation: $1008) for HAPI-related care prior to implementation, versus $3,800 (standard deviation: $923) after implementation, p=0.008. In conclusion, the use of real-time pressure mapping decreased the morbidity and costs associated with hospital-acquired pressure injuries in BICU patients.

Pressure injury prevention practices among medical surgical nurses in a tertiary hospital: An observational and chart audit study

“…Besides, using equipment to reduce pressure and shear is recommended by current guidelines and manual repositioning can be time‐consuming and even result in work‐related musculoskeletal disorders 47 . A interface pressure monitoring can increase efficiency of repositioning and visual feedback provided by pressure mapping also improve proficiency in preventative repositioning 48 . However, relevant equipment such as turning device and pressure mapping were not observed as being available for nurses in our study.…”

“… 47 A interface pressure monitoring can increase efficiency of repositioning and visual feedback provided by pressure mapping also improve proficiency in preventative repositioning. 48 However, relevant equipment such as turning device and pressure mapping were not observed as being available for nurses in our study.…”

Preventing pressure injuries among patients in the intensive care unit: insights gained

“…Therefore, their value in high-risk ICU patients remain often uncertain. Nevertheless, there are two areas where advances in ICU-acquired PI prevention have been made: continuous bedside pressure mapping (CBPM) [ 9 , 10 ] and prophylactic dressing use [ 11 , 12 ].…”

“…Reports from a randomized trial showed a reduced ICU-acquired PI rate with use of CBPM [ 9 ]. Similarly, following the introduction of CBPM, another study showed a reduction in not only the number of ICU-acquired PIs but also the severity of PIs resulting in significant cost savings [ 10 ].…”

“…A systematic review of the effectiveness of prophylactic sacral dressings to prevent PIs, included six studies that all compared the intervention to standard care [ 10 ]. However, four of the six studies were conducted on one dressing type.…”