Integrating Implementation Science to Mitigate Ongoing Hospital Acquired Pressure Injuries in A Large General Surgical Intensive Care Unit
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Date
2024-08
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The Ohio State University
Abstract
The purpose of this evidence-based quality initiative is to address the high occurrence rate of hospital-acquired pressure injuries (HAPI) on a general surgical intensive care unit. This project is twofold: first, it verifies the evidence supporting use of a STAND Skin protocol for HAPI assessment and prevention; second, it highlights how the use of tailored implementation strategies can impact adoption and fidelity to this evidence-based practice. Current literature supports the use of bundled protocols for HAPI prevention and staff adherence. Integrating implementation science using the CFIR framework and ERIC implementation strategy matching tool identifies barriers to practice change and specific strategies for successful implementation. Barriers to implementation were identified through a comprehensive unit assessment. Tailored strategies were then matched to address barriers and included an educational intervention, auditing and feedback, and identifying a project champion. Results for this initiative demonstrated high protocol adoption rates, which remained throughout project implementation. A steady state of protocol fidelity was achieved for turning and positioning with an 8.64% increase from week 1 to week 7; however, no substantial change was observed with offloading device utilization. Fidelity for wound consultation saw a 33.55% increase from week 1 to week 6. Implications from this project seek to highlight the benefits of implementation science methodology, demonstrate economically-conscious approaches to practice change, and sustainable delivery of care.
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Keywords
Hospital-acquired pressure injury, HAPI, implementation science, protocol