Original Publication Date
2019 ANCC National Magnet Conference
Date of Submission
Purpose (What): To achieve sustainable reduction of pressure injury (PI) rates through systematic culture change, in a quaternary, level 1, urban academic medical center cardiac surgery intensive care unit (CSICU).
Relevance/Significance (Why): The CSICU is a high-risk patient population, hosting multiple potential barriers to pressure injury prevention. Prior to 2012, the CSICU pressure injury rate was 17% higher than the National Database of Nursing Quality Indicators benchmark, negatively impacting patient outcomes and organizational goals. Leveraging Magnet principles of Evidence-Based Practice, CSICU advanced practice nurse leaders empowered and motivated bedside nurses to lead and sustain unit culture change.
Strategy and Implementation (How): Initial culture change required accountability to existing outcomes and shared leadership in identifying practice gaps and perceived barriers, resulting in a framework for education and development of an informal rounding process. CSICU bedside nurse champions and unit leadership created and led evidence-based PI prevention classes, educating 100% of staff, then reinforced through role modeling at the point of care during informal daily rounds. Nurses were encouraged to gain knowledge, evaluate processes, collaborate with providers and advocate for products. Simultaneously, organizational leaders committed to supporting the WCT by providing standardized PI prevention resources to all areas of the hospital. Culture change behaviors continue to be assessed, and demonstrated in daily practice, reflecting continued staff investment in outcome improvement despite attrition and increases in patient acuity.
Evaluation/Outcomes (So what): From 2012 to 2013, overall monthly survey PIs and medical device-related (MDR) injuries were reduced by 83% and 52% respectively, for an estimated cost savings of $84,000. From 2013 to 2014, overall PI and MDR injury incidences decreased an additional 45% and 55% respectively. The 2015, 2016, and 2017 surveys yielded zero PIs for nine, 10 and eight months out of each year respectively.
Implications for Practice (And now): CSICU nurses prioritize PI prevention in the critically ill, achieving comprehensive excellence in patient care. High nursing standards, nursing leadership engagement, and a willingness for team members to hold one another accountable has directly impacted the sustainability of culture change.
Is Part Of
VCU Health Nursing