Hospital-acquired pressure injuries are costly and contribute to poor patient outcomes. Unfortunately, they are also on the rise. The Agency for Healthcare Research and Quality reports that between 2014 and 2017 national rates for pressure injuries increased 6 percent, while the rates for all hospital-acquired conditions decreased 13 percent.
During a June webinar hosted by Becker's Hospital Review and sponsored by Smith + Nephew, Annemari Cooley, Senior Director of Clinical Development for Advanced Wound Management at Smith + Nephew, and Robin Gasparini, RN, Clinical Nurse Specialist for Quality at Mayo Clinic in Jacksonville, Fla., discussed how organizations are using turn-cueing protocols and technology to reduce pressure injuries.
Three key takeaways:
- Patient turning and repositioning protocol adherence is low with great variability.. "In task-saturated clinical environments, turning and repositioning isn't always top of mind," Ms. Cooley said. "This is particularly true as acuity increases. There's also great variability and bias in terms of repositioning." Patients are turned less frequently at night than in the day. In addition, patients with high body mass index are turned less often than those with low BMI, and male patients are turned less frequently than females regardless of BMI.
- Patient monitoring systems increase adherence to turning protocols and eliminate variability. With the LEAF Patient Monitoring System, patients wear a sensor on their chest like a sticker. These sensors monitor turn frequency, turn adequacy and tissue recovery time. When patients turn on their own, the sensors automatically reset the turn clock. The Integrated Positioning Index algorithm determines whether a patient needs repositioning and translates alerts into simple red, yellow and green visual indicators. One study found 98 percent average turn protocol adherence using the LEAF System, compared to 64 percent without the system. In an investigator-led randomized control trial, the patient in the blinded arm and intervention arm all received a LEAF Sensor, but only clinicians in the LEAF intervention arm used the system as intended receiving the visual turn status cues. The study found 73 percent fewer hospital-acquired pressure injuries in the LEAF intervention arm than the control arm.
- Mayo Clinic, Jacksonville found that the LEAF System helped reduce pressure injuries and delivered a favorable ROI. Mayo Clinic, Jacksonville conducted a three-month quality improvement project in the ICU focused on pressure injuries. "We were excited by the LEAF product because it was an innovative way to transform our turning protocol compliance and to emphasize the importance of reducing pressure injuries," Gasparini said. "We also appreciated the ability to link the sensors to our documentation platform to create real-time nursing intervention documentation." Mayo Clinic saw a 56 percent improvement in turn protocol adherence, a 67 percent reduction in the pressure injury incidence rate and no patients who received a LEAF Sensor and high turn protocol adherence suffered a HAPI. The return on investment for the pilot was $536,000 and the team estimated the annual house-wide ROI for LEAF System at $3.4 million based on 2018 data.
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1 Pickham D, Pihulic M, Valdez A, Mayer B, Duhon P, Larson B. Pressure injury prevention practices in the ICU: Real world data captured by wearable patient sensors. Wounds. 2018;30(8):229-234.
2 Schutt, S. et al. Pilot study: Assessing the effect of continual position monitoring technology on compliance with patient turning protocols. Nursing Open. 2018; 5:21-28
3 Pickham D et al. Int J Nurs Stud. 2018 Apr; 80:12-19. doi: 10.1016/j.ijnurstu.2017.12.012. Epub 2017 Dec 30.