Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov-Dec;48(6):510-515.
doi: 10.1097/WON.0000000000000815.

Pressure Injury Prevention for Complex Cardiovascular Patients in the Operating Room and Intensive Care Unit: A Quality Improvement Project

Joyce Pittman  1   2   3   4   5   6   7   8 , Dawn Horvath  1   2   3   4   5   6   7   8 , Terrie Beeson  1   2   3   4   5   6   7   8 , Karrie Bailey  1   2   3   4   5   6   7   8 , Annie Mills  1   2   3   4   5   6   7   8 , Laura Kaiser  1   2   3   4   5   6   7   8 , Deborah K Hall  1   2   3   4   5   6   7   8 , Jennifer Sweeney  1   2   3   4   5   6   7   8
Affiliations

Pressure Injury Prevention for Complex Cardiovascular Patients in the Operating Room and Intensive Care Unit: A Quality Improvement Project

Joyce Pittman et al. J Wound Ostomy Continence Nurs. 2021 Nov-Dec.

Abstract

Purpose: The purpose of our project was to examine the effect of an alternating pressure (AP) overlay on hospital-acquired pressure injury (HAPI) in high-risk cardiovascular surgical patients.

Participants and setting: This quality improvement (QI) initiative was conducted in a core group of 8 cardiovascular operating room (OR) suites and 1 cardiovascular surgical critical intensive care unit (ICU) in a large Indiana-based academic hospital. The sample comprised adult patients who underwent complex cardiovascular surgical procedures and those in the cardiovascular surgical ICU with extracorporeal membrane oxygenation (ECMO), ventricular assistive device (VAD), and undergoing heart and/or lung transplant, or open chest procedures.

Approach: The AP overlay was placed on OR cardiovascular foam surfaces and on selected ICU support surfaces for patients who met inclusion criteria. We used a pre/postcomparative QI design to assess outcomes including OR-related HAPI rates, ICU aggregate unit HAPI data, related costs, and staff satisfaction during the 3-month project period.

Outcomes: Operating room-related HAPIs were reduced from 8/71 (11%) preintervention to 0/147 (0%) postintervention (P = .008), resulting in a cost avoidance of $323,048 and positive staff satisfaction (mean = 3.85; 1- to 4-point Likert scale). No adverse outcomes occurred. Although not significant, ICU HAPI rates decreased from 10 to 7 pre/postintervention (P = .29), demonstrating a 14% HAPI reduction with a cost avoidance of $121,143. The ICU incidence density decreased from 3.57 to 3.24; however, there was no decrease in ICU monthly unit prevalence. Critical care staff satisfaction was positive (mean = 2.95; 1- to 4-point Likert scale) with most staff members preferring the AP overlay to a fluid immersion surface. A cost savings of 48% (AP overlay vs fluid immersion rental) was identified in the ICU.

Implications for practice: We achieved fewer HAPIs and reduced costs and observed positive staff satisfaction, along with no adverse events with the use of the AP overlay. Further research is needed to determine the safety and efficacy of this device for this pressure injury prevention option for immobile patients in both the OR and the ICU.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Alternating pressure overlay with pressure points.
Figure 2.
Figure 2.
Operating room–related hospital-acquired pressure injuries pre- and postintervention. OR-HAPI indicates operating room–related hospital-acquired pressure injury.
See this image and copyright information in PMC

References

    1. Park S, Park H, Hwang H. Development and comparison of predictive models for pressure injuries in surgical patients: a retrospective case-control study. J Wound Ostomy Continence Nurs. 2019;46(4):291–297. - PubMed
    1. Padula W, Black J, Davidson P, Kang S, Pronovost P. Adverse effects of the Medicare PSI-90 hospital penalty system on revenue-neutral hospital-acquired conditions. J Patient Saf. 2018;16(2):e97–e102. - PubMed
    1. Agency for Healthcare Research and Quality (AHRQ). AHRQ National Scorecard on Hospital-Acquired Conditions: Updated Baseline Rates and Preliminary Results 2014-2016. Rockville, MD: AHRQ; 2018.
    1. Chen HL, Chen XY, Wu J. The incidence of pressure ulcers in surgical patients of the last 5 years: a systematic review. Wounds. 2012;24(9):234–241. - PubMed
    1. Cox J. Predictors of pressure ulcers in adult critical care patients. Am J Crit Care. 2011;20(5):364–375. doi:10.4037/ajcc2011934. - PubMed