Miller Megan W, Emeny Rebecca T, Freed Gary L
Department of Wound Care Services, Dartmouth Hitchcock Medical Center, Lebanon, NH.
The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH.
Wounds. 2019 Apr;31(4):108-113. Epub 2019 Feb 14.
Hospital-acquired pressure injuries (HAPIs) increase patient mortality and length of stay (LOS). Twenty-eight full-thickness HAPIs occurred in fiscal year 2015 (FY15), and that trend continued into FY16 with 14 injuries on multiple units throughout a tertiary acute care center with 400 beds. To address this trend, a multidisciplinary Pressure Injury Prevention (PIP) team was created.
This report is a description of ongoing, hospital-wide efforts to understand the common factors of HAPI causality and to establish corrective action plans institutionally to prevent similar events in the future.
The team goals were to document the occurrence of HAPIs across all hospital units, reduce preventable full-thickness PIs to zero, and recommend institution-wide changes as those opportunities were recognized.
Since the committee's inception in July 2015, an 89% reduction of full-thickness HAPIs, with only 2 full-thickness HAPIs in FY17 and 3 in FY18, has been seen. This effort has been hospital wide with involvement of all inpatient units and perioperative areas (including the operating rooms). Opportunities remain for improvement around the prevention of deep tissue and partial-thickness HAPIs.
The data demonstrate that the formation of a multidisciplinary PIP team of engaged clinicians can reduce the number of preventable full-thickness HAPIs.
医院获得性压疮(HAPI)会增加患者死亡率和住院时间(LOS)。2015财年(FY15)发生了28例全层HAPI,这种趋势在2016财年仍在持续,在一家拥有400张床位的三级急性护理中心的多个科室出现了14例此类损伤。为应对这一趋势,成立了一个多学科压力性损伤预防(PIP)团队。
本报告描述了正在进行的全院范围的努力,以了解HAPI因果关系的常见因素,并在机构层面制定纠正行动计划,以防止未来发生类似事件。
该团队的目标是记录全院各科室HAPI的发生情况,将可预防的全层压疮发生率降至零,并在发现机会时建议全院范围的变革。
自2015年7月委员会成立以来,全层HAPI减少了89%,2017财年仅有2例全层HAPI,2018财年有3例。这项工作在全院范围内开展,所有住院科室和围手术期区域(包括手术室)都参与其中。在预防深部组织和部分厚度HAPI方面仍有改进空间。
数据表明,由积极参与的临床医生组成的多学科PIP团队的组建可以减少可预防的全层HAPI的数量。