Pressure Injury Prevention in Cardiac Surgery Using Risk Factor Assessment and Standardization
Critical Care Nursing
Perioperative, Operating Room and Surgical Nursing
Cardiac surgical patients are more susceptible to pressure injury (PI) than other surgical specialties, and little is known about PI prevention (PIP) in this population. How do PIP strategies, compared to standard care, affect the incidence of PI during the post-operative recovery among adult cardiac surgery patients? The aim was to reduce the incidence of UAPI in an adult CVSICU by 5% in six weeks. The conceptual framework chosen was The Iowa Model Revised, and the theoretical framework employed was the Theoretical Model for Lesion Development. Quality improvement, single-group pretest-posttest design. Sample consisted of 69 cardiac surgery, LVAD, ECMO patients at Johns Hopkins CVSICU. The intervention was a standardized PIP bundle provided to “highest risk” patients screened before surgery. Outcome measures were UAPI count and incidence rates. Process measures were percentage of patients screened, prophylactic sacral dressing, rental bed cost. Balancing measures were PI severity, anatomic location, and time between wounds. Baseline data consisted of historic data and intervention data consisted of weekly survey observations. Implementation consisted of staff education, daily preoperative screening, weekly wound rounds. 33% of patients screened as “highest risk” and received the PIP bundle. PI count decreased from 25 to 13 during implementation and wound stages improved. Chi Square test of 2-proportions showed a reduced PI incidence of 8.56% (Z=1.66, p= .048) and 2-sample Poisson rate showed significance in count (Z=1.95, p=.036). Location changed to nose, buttocks, and occipital locations. There was an overall cost savings of $78,660. Reducing PI lead to reduced morbidity and cost.