Implementation of a care bundle model for pressure injury prevention, a DNP project

Background: A small suburban hospital in the southern United States has seen an increase in hospital-acquired pressure injuries over the past two fiscal years. Care bundles are evidence-based interventions used in healthcare to standardize preventative measures and improve patient outcomes. The evidence-based SSKIN care bundle highlights five elements of pressure injury prevention: skin assessment and inspection, surface support, mobility, incontinence management, and nutrition status to address early detection of skin breakdown and promote preventative measures. Objectives: The purpose of this project is to evaluate the impact of the SSKIN care bundle in targeting the main causes of pressure injuries, help standardize nursing interventions and documentation, and decrease the occurrence of pressure injuries. Setting and Stakeholders: This 12-week project was implemented on a 28-bed telemetry unit at a 297-bed suburban hospital. Stakeholders involved included 56 registered nurses, 20 patient care technicians, two wound care champions, and patients. Methods: Nurses completed a pre-survey to determine knowledge and experience related to pressure injury prevention. Education was provided at unit-based council meetings and huddles. A post-survey was distributed to demonstrate practical application. The SSKIN care bundle was implemented for patients with a Braden Scale score of 18 or less and used to enhance nursing documentation in four areas: Skin Assessment, Skin Interventions, Braden risk assessment, and Braden interventions. Project progress was tracked weekly through chart auditing for documentation compliance, monthly from the HAPI dashboard for pressure injury incidences, and pre- and post-surveys. Results: Ten nurses (n = 10) participated in the baseline pre-intervention survey. Two nurses (n = 2) completed the post-survey. Nursing staff demonstrated a 75.71% average of strong agreement regarding their clinical confidence and knowledge in preventing pressure injuries. For the post-survey, nursing staff demonstrated a 71.43% average of strong agreement indicating a high level of self-reported competence using the SSKIN care bundle. Two new HAPI occurrences reported representing an incidence rate of 2.88 HAPIs per 1,000 patient days. Chart audit results indicated 100% compliance with Braden Risk Assessment and Skin Assessments, Braden Interventions at 99.56% compliance, and Skin Interventions at a compliance rate of 45.32%. Implications: Integration of the care bundle into the EHR workflow by having a real-time decision support tool allowing nurses to identify at-risk patients sooner, facilitate documentation integrity, and ensure that skin interventions become a consistent component of their daily routine. The primary implication is the correlation between sustained care bundle adherence and the mitigation of HAPI incidence to promote patient safety. The care bundle utilizes an interprofessional approach empowering nursing staff to identify early skin changes and report them to the interdisciplinary team to foster a culture of shared responsibility to promote patient safety.

Author dc:creator

• Miller, Jessica A. (Nurse practitioner)

Contributors dc:contributor

• Winowiecki, Joshua M. (Joshua Michael)

• Bedsores--Prevention
• Evidence-based nursing
• Hospital patients--Care

Statement dc:rights

• In Copyright

Language dc:language

English

Identifier

dnp:101
oclc:1601633993
local:R_7KWWMztjVUJFxjH

OAI identifier oai:identifier

oai:d.lib.msu.edu:dnp_101