Abstract
Introduction
Patients with dermal burns are at a greater risk of developing pressure injury secondary to critical illness and increased length of stay. Our burn center had four hospital-acquired pressure injuries, grade two or greater, in two months within our patient population. This incidence placed the burn unit in the top five units at our institution with the highest prevalence of hospital-acquired pressure injury. After discussion with nursing staff, we discovered a large variance in pressure injury prevention strategies, many of which were not focused on heel protection.
Methods
With rising prevalence, the burn team assembled a multidisciplinary team to combat the issue. The team consisted of day and night shift staff nurses, quality improvement nurse, physical therapist, and nursing management. We examined heel injury prevention evidence-based practice and then modified it for our unique patient population to develop a recommendation for best practice on our unit. The recommendations, affectionately known as the Hip Hip Heels Raised Campaign, include:
Results
To assess compliance to the new unit recommendations, patient positioning audits were completed before and after staff education. Prior to instruction and implementation of the campaign, compliance with heel elevation varied from 75–83%. With this information in mind, our goal was to achieve greater than 90% compliance during audits by January, with education beginning in mid- November. Our goal was met the week of December 27, 2018 and compliance has remained strong, averaging 92% implementation of heel elevation since campaign implementation.
Conclusions
Per the AHRQ, the average cost of a hospital acquired pressure injury averages $43,180. Our retrospective analysis for patients in our burn center discovered four pressure injuries, grade two or greater, in a two-month period prior to the campaign implementation. Over the five-month span since campaign application, only three pressure injuries have occurred in our patient population, a reduction of approximately seven pressure injuries. This reduction is the equivalence of $300,000 in patient care costs saved.
Applicability of Research to Practice
This model worked well for our unit and it is applicable to practice in the burn population because it is simple to implement and good for patient care outcomes.
The Standardized Pressure Injury Prevention Protocol for improving nursing compliance with best practice guidelines
