Impact of Nurse-Implemented Intervention Bundle on HAPI Prevention in Cardiac ICU

An article published in Critical Care Nurse (CCN) entitled “Reducing Hospital-Acquired Pressure Injuries in a Cardiothoracic Intensive Care Unit” highlights a nurse-led quality improvement project in a 10-bed ICU at Catholic Health Long Island’s Good Samaritan University Hospital, West Islip, New York.

A press release on the article said, “An easy-to-use worksheet that combined an assessment scale designed to identify critically ill patients at risk for developing a pressure injury with specific interventions to address each risk contributed to a decrease in healthcare-associated pressure injuries (HAPIs) for patients in a New York hospital’s cardiothoracic intensive care unit (ICU). Findings from the performance improvement project are published in Critical Care Nurse (CCN).”

The majority of patients in the specialty unit were recovering from open heart surgery and transcatheter aortic replacement. Other patients had complex cardiac conditions that sometimes needed mechanical support devices like intra-aortic balloon pumps (IABPs), ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO).

The press release added, “Cardiac patients are at especially high risk for developing HAPIs, and the unit’s average prevalence rate was 11.01% for the 24-month period prior to the initiative, higher than national benchmarks. The rate was despite the hospital’s standard of care for HAPI prevention: assessing the patient’s skin and risk factors at each nursing shift with the widely used Braden scale and addressing the identified risk factors with the SKIN care bundle (surface, keep turning, incontinence care and nutrition).

Further, “For the project, the team designed a simple tool that linked bundled HAPI prevention interventions to risks identified by the Cubbin-Jackson scale, a pressure injury risk-assessment scale specifically for ICU patients. Nurses completed a paper version of the tool in addition to performing the existing standard of care.”

Author Sunday Caldwell, DNP, NP, ANP-BC, NE-BC, nurse practitioner and director of cardiac intensive care at the hospital was quoted in the release saying that “We developed a tool to guide nurses to implement a preventive intervention bundle for each specific risk factor identified, allowing them to tailor care to each patient’s individual needs. The combination resulted in a decrease in HAPIs, improving patient outcomes and avoiding a variety of costs.”

The intervention group comprised of all patients admitted to the cardiothoracic ICU during an eight-week period. The rates of HAPIs were compared with a review of past medical records from a preintervention group of all patients admitted during the prior eight weeks. Each group consisted of 102 patients, and nurses completed the Cubbin-Jackson assessment for 89 patients in the group.

The press release detailed, “In the preintervention group, four patients experienced HAPIs, of whom three had sacral HAPIs. In the intervention group, three patients developed HAPIs, of whom only one had a sacral HAPI that developed quickly, within 72 hours of an 11-hour surgery,

“The prevalence rate fell 67.84% (from 22.2% to 7.14%), and the incidence rate decreased 36.43% (from 13.56% to 8.62%), which isn’t considered statistically significant due to the small number of patients with HAPIs.

“Although medical device-related pressure injuries are clinically concerning, sacral deep tissue injuries are the most concerning given their potential to advance to higher-stage pressure injuries; therefore, the decline in this type of injury is clinically significant.”