Abstract
Purpose: The purpose of this quality improvement project is to reduce Hospital Acquired Pressure Injury (HAPI) occurrences in patients undergoing scheduled surgical intervention at a large academic teaching institution.|Background: Approximately 16 million operations occurred nationwide in 2010. A reported, two and a half million patients develop HAPIs annually. HAPIs are considered never events for stages III and IV. Hospitals are not reimbursed for never events, resulting in an accrued cost of $20,900 to $151,700 per injury. Pressure injuries from surgical procedures can take 48-72 hours to develop. Despite evidence-based protocol and polices in place, our hospital continues to have incidence of perioperative HAPIS, thus initiating this quality improvement project.|Sample/Setting: The patient population impacted by this quality improvement project are patients undergoing scheduled surgical procedures lasting greater than two hours and who are placed in the supine position. Staff included in positioning competencies included all staff in the circulator role. The setting of this quality improvement project is the operating rooms of a large academic teaching institution in the Omaha area. This includes 28 operating room suites.|Methods: A CNL MSN student facilitated an interprofessional project team in a six sigma improvement appoarch, following the DMAIC framework of Define Measure Analyze Improve Control. Based on discussion with key stakeholders, it was determined that not all staff members were following positioning protocols, including the use of all available positioning devices. A needs assessment indicated that while staff members had been educated on protocols and devices, validation of competencies were needed. Staff members participated in competency test outs of proper patient positioning practices to reduce injury. Data were gathered to determine frequently used positioning devices and pressure injury incidences pre and post project implementation.|Results: Overall, staff demonstrated an understanding of evidence-based practice guidelines. Deviation from best practice was influenced by provider and patient factors.|Conclusion: Safe patient positioning driven by evidence-based practice in the perioperative setting is imperative in preventing patient harm. Utilizing The DMAIC can assist in influencing improved process changes and improved patient outcomes.