ADVERTISEMENT
Preventing Pressure Injuries in Critical Care with Air Overlays and Nursing Satisfaction
Background: A pressure injury is localized damage to the skin and underlying soft tissue. Pressure injuries occur as a result of intense or prolonged pressure, or pressure in combination with shear. Hospital acquired pressure injuries (HAPI) are pressure injuries that develop while a patient is in the hospital.
Objective: A problem was identified when critical care units noticed an increase in HAPIs. These injuries occur more often in patients with extended surgery time, abnormal body mass index, vasopressor use, mechanical ventilation, or hemodynamic instability. The wound care team partnered with critical care staff to identify high risk patients and intervene to decrease these painful events.
Methods: In March 2019, the wound care team created a mixed methods study to test if air overlays would decrease the risk of HAPIs in critical care units. This observational study compared data collected from a prospective cohort of subjects who were over 18 years old, admitted to a critical care unit, and utilized an air overlay. The data was compared to a historical control group of subjects with the same qualifiers except an air overlay was not utilized. In addition, a subject group of attending nurses was administered a survey measuring satisfaction regarding their experience with the air overlay.
Results: The wound care team discovered the use of air overlays decreased HAPIs in the critical care units by 66%. Additionally, this also created a 74% cost saving per patient compared to renting an advanced surface. The nursing staff survey exhibited overall satisfaction with use. Nursing staff also reported overlays are easily initiated, including by nursing assistants and that the air overlay made turning patients easier.
Conclusions: The study and survey results showed that air overlays should be used to decrease HAPIs for patients in critical care units who are at risk during their entire hospitalization. The patient should continue using air overlays after discharge to continue the preventive benefits.
References
Clinical Guidelines for Use of Waffle Mattress Overlay. EHOB. 07/2017 Vermette, S., Reeves, I. & Lemaire, J. (2012). Cost Effectiveness of an Air-inflated Static Overlay in Pressure Ulcer Prevention: randomized control trial. Wounds. 24(8):207-214. https://shop.ehob.com/bedding/waffle-extended-care-plus-mattress-overlay-with-m.a.d.-pump/. Retrieved on 1/21/2019. Preventing pressure ulcers: a patient guide. http://www.cdss.ca.gov/agedblinddisabled/res/VPTC2/8%20Paramedical%20Services/Preventing_Pressure_Ulcers_Patient_Guide.pdf. Retrieved on 01/18/2019. http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-injury-stages/. Retrieved on 1/21/2019. Qaseem, A., Mir, T., Starkey, M. & Denberg, T. (2015). Risk Assessment and Prevention of Pressure Ulcers: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine Vol.5 162:359-369. Warner, J. & Cherok, A. (2018) Pressure Injury Prevention: Exemplary Strategies Sustain Zero is Par for the Course. West Penn Hospital.
