Date of Doctor of Nursing Practice Project Completion
2026
Faculty Advisor
Dr. Robert Carl Coghlan III
Abstract
Purpose
The goal of this quality improvement project was to utilize the SKINSAFE pressure injury prevention bundle during 12 weeks of implementation to increase evidence-based pressure injury prevention practices adherence and decrease risk of hospital-acquired pressure injury (HAPI) in the intensive care units (ICU).
Background
ICU patients experience high risk for hospital acquired pressure injuries (HAPIs) secondary to immobility and device related pressure. Initial adherence to SKINSAFE bundle was 55-56%. There was inconsistent use of heel offloading devices, wound photography and documentation. Prevention bundles were affected by staffing fluctuations and leadership turnovers.
Methodology
The Plan-Do-Study-Act cycle for this project included staff education about the SKINSAFE bundle, use of reminder boards/unit champions/bedside prompts, wound care consults, and weekly audit-feedback sessions. Outcome measures included weekly compliance audits, pre/post adherence to bundle elements, and HAPI rates.
Results
In conclusion, the SKINSAFE bundle compliance improved from 55% to 85%, including documentation of heel offloading and wound photography. The number of HAPI events increased from 2 at baseline to 5 during implementation possibly due to patient acuity, staffing and leadership changes.
Implications
Adoption of the SKINSAFE bundle demonstrated improved adherence to evidence-based guidelines for prevention of pressure injuries in the ICU. Patient safety was enhanced through staff education utilizing audit-feedback. Decreases in HAPI did not occur immediately after implementation due to fluctuations in staffing, changes in leadership, and patient acuity level. Continued efforts are necessary to realize a reduction in incidence and improvements in cost savings due to fewer HAPIs.
Keywords
Pressure injury, Prevention, Intensive Care Unit (ICU), Quality Improvement, Evidence-Based Practice, Plan-do-study-act (PDSA) cycle, Bundle compliance
Recommended Citation
Xibo Lan, "Implementation of a Pressure Injury Prevention Bundle to Reduce Hospital-Acquired Pressure Injuries in the Intensive Care Unit" (2026). Doctor of Nursing Practice Final Project Abstract. 172.
https://digitalcommons.library.tmc.edu/dnp_abstract/172
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Critical Care Commons, Critical Care Nursing Commons, Educational Leadership Commons, Geriatric Nursing Commons, Occupational and Environmental Health Nursing Commons, Physical Therapy Commons, Preventive Medicine Commons, Public Health and Community Nursing Commons, Quality Improvement Commons