How to keep patients un-HAPI: Cardiac surgery and sacral pressure injuries: Invited expert opinion: Hospital-acquired pressure injuries

Evaluating the Effectiveness of an Alternating Pressure Overlay in Patients Undergoing Cardiothoracic Surgery

LOCAL PROBLEM

In 2019 and the first half of 2020, our facility experienced an increase in the number and severity of hospital-acquired pressure injuries (HAPIs) among our cardiothoracic surgery population. Fifty percent of these HAPIs occurred within 72 hours of surgery. A review of the literature revealed that alternating pressure overlays (APOs) have been successfully used to prevent HAPIs in surgical patients.

PURPOSE

The primary purpose of our quality improvement (QI) project was to measure perioperative HAPI rates in cardiothoracic surgery patients after the addition of APOs to our HAPI prevention protocol. Our secondary purpose was to identify common factors among those patients who developed HAPIs.

METHODS

This QI project collected both pre- and postintervention data and compared the findings. A nurse-led team was responsible for measuring HAPI rates during the intervention-from July through October 2020-which involved placing an APO under cardiothoracic surgery patients during the 72-hour perioperative period. APOs were placed on all operating room (OR) tables and remained with the patients following surgery. Bed linens and skin care products were standardized for consistency. Lifts were used to reduce friction during repositioning.

RESULTS

During preintervention data collection, we identified 10 patients who developed HAPIs (seven out of 1,174 cardiothoracic surgery patients in 2019, for a HAPI rate of 0.6%, and three out of 333 patients in the first half of 2020, for a HAPI rate of 0.9%). During the four-month intervention period, in which APOs were used in 331 patients undergoing cardiothoracic surgery, no HAPIs developed.

CONCLUSION

Use of an APO in cardiothoracic ORs and critical care units may help reduce HAPI rates.