Use of a Pressure Injury Bundle in a 101 Bed,Level IV NICU to Decrease Respiratory Device-Related Pressure Injuries

Abstract

Background:

The incidence of Hospital-Acquired Pressure Injuries (HAPIs) are a national concern due to patient morbidity, treatment cost, and reimbursement issues. Stage III, IV and unstageable pressure injuries that occur during hospitalization are among the conditions considered preventable by the Centers for Medicare and Medicaid Services (CMS). Pressure injuries in total affect 2.5 million patients annually.

Methods:

In 2016, Norton Children's Neonatal intensive care unit and respiratory therapy department began collaboration as part of our medical center's "Reaching For Zero" campaign to eliminate preventable harm to our pediatric patients. With a focus on reducing the incidence of respiratory device related pressure injuries, a multidisciplinary approach was utilized. Education was provided to RT and RN staff regarding early recognition and treatment of pressure injuries. This education also included and focused on a NICU specific HAPI prevention bundle. Clinical staff were empowered to evaluate, monitor and institute preventable measures at the earliest stage. Bundle compliance, strengths, weaknesses, and 'days since' last pressure injury were displayed and discussed in both daily nursing and multidisciplinary huddles. Components of the bundle include but are not limited to: padding under the respiratory device, frequent repositioning of the patient and assessment of proper fit of respiratory device every 3-4 hours.

Results:

To date, Norton Children's Hospital NICU has effectively reduced patient harm and prevented Stage III, IV or unstageable pressure injuries from a respiratory devices. Focus on increased awareness with regular monitoring and assessment has proved beneficial in reducing our overall incidence of pressure injuries resulting in 790 days without a Stage III, IV or unstageable injury.

Conclusions:

Use of a care specific bundle has decreased respiratory device related pressure injuries which contribute to the majority of overall NICU pressure injuries. Utilizing a multidisciplinary team to raise awareness and regularly monitor incidence of respiratory device related pressure injuries has proven effective in reducing patient harm and the overall incidence of pressure injuries. Our work continues to further reduce and sustain zero stage III, IV and unstageable pressure injuries with development of a respiratory device pressure injury bundle. This specific bundle will further aid us in achieving our overall goal of "Reaching for Zero".