240 - Reducing Hospital Acquired Pressure Injury (HAPI) in CVOR
Description: Reducing Hospital Acquired Pressure Injury (HAPI) in CVOR 20 CVOR Pressure Injuries (PIs) 12/01/2016 -04/20/2018 90 Day Pilot Project Summary Alternating pressure mattress x 90 days/1111 Cases: No PIs 2 potential PIs: mattress was not turned on Preventive dressing applied to sacral area in pre-op holding Preventive dressing to heels in OR 17 Sacral pressure injuries: 11 without dressings and 6 with 1 Heel pressure injury with dressing 2 Back pressure injuries with no dressings ABSTRACT A perioperative pressure injury is any pressure-related injury that appears within the first 48-72 hours after surgery. Hospital-acquired PIs (HAPIs) negatively impact clinical outcomes, quality of life, healthcare cost and have become a “never” event from the standpoint of Medicare reimbursement. (AHRQ). Any patient undergoing surgery are at risk for pressure injury. The Cardiovascular surgical patient population are at high-risk for HAPIs due to co-morbidities, ASA score greater than three and surgical procedures longer than 3 hours, exposing the patient to prolonged unrelieved pressure on the skin, possible friction and/or sheering during transfer. Pressure injury prevent in the CVOR perioperative setting is an enormous undertaking, as options to reposition patients to relieve pressure are limited during cardiac surgery.
Purpose: Today’s State-of-the-art Medical technology has manufactured Overlays that are engineered to address primary device related factors (such as prolonged pressure, skin shear, heat and moisture removal at the support surface interface) that contribute to pressure ulcers and discomfort in patients who are immobilized. The purpose of this project is to evaluate the effectiveness of the dynamic support of an alternating low-air loss profile surface that provides periodic off-loading to augment tissue perfusion, and removes excess heat and moisture that can contribute to pressure injuries. Description of the nursing initiative: To implement best practices related to reducing pressure injuries in CVOR. Implementation strategies: Conduct a 90 Day Pilot Project utilizing a low-profile, alternating pressure overlay system on all 8 CVOR beds for all cases for 90 days, regardless of risk factors to evaluate its effectiveness in preventing peri-operative HAPIs during cardiac surgical procedure. Evaluation of the impact/effectiveness on the organization: During the 90-day pilot, 1109 cardiac procedures were performed with the use of the overlay and 1109 cardiac patients did not develop a PI with the use of the alternating pressure overlay. Following the pilot, the department converted back to historical pressure injuries, averaging 1.25 patient(s)/month. The novel technology was easily adopted by key stakeholders, operating staff, surgeon and patients with no adverse effects. The pilot project provided evidence that the innovative overlay system prevented peri-operative pressure injuries for 3 months, a total of 1109 cardiac patients. Further studies are underway to evaluate the ongoing effective and implementation of the overlay for the CVOR department with the intention to be utilized in other operating rooms were patients undergo long duration surgeries. Implications for nursing practice: Implications for perioperative nursing practice include utilizing an alternating pressure overlay as a measure to mitigate the risk of pressure injury in surgical patients scheduled for procedures 3 hours or greater in length. Ongoing, evidence based data and additional research is needed to identify best pressure injury prevention positioning devices that may be applied to all types of surgical patients. Literature Support: The best treatment for a pressure injury is PREVENTION. Author Bio and Education Joan G. Maschke MSN, RN, CNOR, RNC Clinical Nurse Educator for Systems Surgical Services at Florida Hospital, Orlando, Florida. Previously to this role, 25 years in the operating suites. My interest, for pressure injury prevention grew, when I become a member of Florida Hospital HAPU Committee. Opportunities for improvement were identified. I became the lead of a special HAPI task force for Surgical Services. Obtained nursing diploma at Centennial College in Scarborough, Ontario, Canada. Immigrated to the United States in 2004 and pursued a Bachelor’s of science degree in nursing, Master of Science Nursing Informatics with American Sentinel University on-line education. Comprehensive multi-system level, knowledge and experience pursuing opportunities to expand and develop leadership strategies with the latest technologies in our healthcare delivery system. Certification Perioperative Nursing Practice: CNOR and National Certification Maternal Newborn Nursing: RNC Professional Associates: AORN, Sigma Theta Tau International Honor Society of Nursing, and College of Nurses. Conflict of Interest (COI) Declare no affiliations that could be perceived as conflicts of interest for this poster presentation.