Turning Points: Reducing Hospital-Acquired Pressure Injuries in Critical Care

PURPOSE The purpose of this quality improvement initiative was to evaluate the effectiveness of education and the implementation of a turning and repositioning system in critical care for unstable patients in reducing hospital-acquired pressure injuries (HAPIs). PARTICIPANTS AND SETTING Fourteen patients met inclusion criteria. This project was conducted in 2 intensive care units of a large academic teaching hospital in Central Texas of the United States. APPROACH The project used a pre–post quasi-experimental design. The wound nurse, Intensive Care Unit leadership, and nursing staff collaborated to address the practice gap. The wound care nurse recommended educating nurses on critical care–specific prevention strategies and trialing a turning and repositioning system. A risk assessment algorithm and a repositioning checklist were created. Daily rounds on participating patients validated staff nurse's knowledge, skills, and the proper use of the system. Evaluation forms were collected for feedback. OUTCOMES Positive feedback was received, demonstrating the effectiveness of the education provided and the usability of the turning and repositioning system in preventing pressure injury in critically ill patients. Hospital-acquired pressure injury rates decreased to zero at the end of the QI project. Post-trial rates remained zero for 2 months, with 1 HAPI identified in the third month, yielding a rate of 0.4 per 1000 patient days. IMPLICATIONS FOR PRACTICE Providing education and implementing the turning and repositioning reduced the incidence of HAPIs by more than 90%. Adding the turning and repositioning system to pressure injury prevention interventions reduced the number of HAPIs in the critical care population.