Perioperative Pressure Injury Prevention
Topic of Interest
Quality Initiatives
Interprofessional Collaboration
Abstract
Title: Prevention of Perioperative Pressure Injuries (PPI)
Description: Patients who have undergone surgery at Tripler Army Medical Center (TAMC) have developed PPI at an increasing rate.
Objectives: In perioperative patients undergoing surgery at TAMC will an evidence-based PPI prevention bundle compared to current practice result in a decrease in PPI with a goal of decreased occurrences in the year following implementation.
Background: Incidence of PPI at Tripler Army Medical Center (TAMC) has increased from 3 in 2018 to 7 as of December 2019. National incidence of PPI has a pooled incidence rate of 15%. Evidence supports the use of a trigger system (Scott Triggers) for initiation of PPI prevention modalities in the reduction of PPIs.
Methods: 20 articles were compiled utilizing the CINAHL and PubMed databases. Evidence synthesized supports the use of a PPI bundle in concert with skin assessment tool to achieve reduced occurrences of PPI. A multidisciplinary team of CNSs, nurses, certified wound ostomy nurses, surgeons, leaders, and educators created an evidence-based PPI prevention bundle that includes PPI risk assessment trigger tools, workflow changes, preventative protection of pressure dependent skin with five layer silicone dressings, communication tools, root cause analysis, and wound care follow up.
Findings: The project was initiated December, 2019 with PPI’s being tracked monthly. Preliminary results will be available for presentation by March 2020. PPI tracer data to support compliance with bundle initiatives include the use of Scotts Triggers risk criteria, patient positioning, use of PPI prevention interventions, 24 hour and 72 hour post-operative rounding on 10 patients per month.
Implications for military nursing: A multidisciplinary team in concert with leadership is influencing the perioperative environment to embrace a culture of quality, safety, and continuous process improvement related to the prevention of PPI. Once thought of as a clinical problem specific to inpatient care, pressure injury prevention in the perioperative setting extends prevention into the preoperative, intraoperative, and postoperative phases of care to achieve surgical outcomes free of PPI to support better care, better health, lower cost, and increased readiness.