Team Approach to Prevention

Objective: Pressure injury prevention is a challenge. A 220-bed hospital in the central Midwest accomplished over 1,000 calendar days without pressure injury on two hospital units. Goal of sustainability in hospital-wide prevention.

Methods: Standardization of care and practice has been a factor in prevention. Identification of inconsistencies in assessments and care led to standardization. Success was accomplished by empowerment of champions for focused skin assessments and prevention initiatives. Keys to prevention included collaboration and standardization of assessments and interventions to prevent pressure injuries.

Bundle:

2015 – a bordered sacral foam on all with a Braden 18 or less, a positioning system on all needing sustained positioning. Integration of call light reminders for turning. Standard two-person assessment for admission and transfer. Patient care tech focus groups on barriers to care.

2016 – In addition, a foam dressing under all oxygenation masks and converted to silicone oxygen tubing. Heel protector boots with port for sequential tubing. A brief-less in bed concept.

2017 – Support from units including Operating Room and Ambulatory Care. Silicone-bordered heel dressing available for prevention.

2018 – Mandatory education for all patient care techs on importance of prevention and their role in implementation. Waffle overlay for mattress implementation.

Result:

2015 – Twenty-eight pressure injuries, prompting practice change and program overhaul led by the WOC RN’s. WOC RN consistency and unit oversight improved.

2016 – Pressure injury incidence decreased by half, 14 total, half of injuries related to medical devices.

2017 – Incidence of 20, a continued decrease from initial implementation. Organization reeducation was completed to ensure prevention remains present in the daily cares.

2018 – Nineteen hospital-acquired injuries.

Conclusion: A successful prevention program is a work in process and methods for success have been hardwired in all nurses, patient care techs, and support staff. The focus of prevention is the new culture with limitless possibilities.