Quality Improvement Intervention Bundle Using the PUPPIES Acronym Reduces Pressure Injury Incidence in Critically Ill Patients

Jillian M McLaughlin; Jacquelynn P Tran; Samee A Hameed; Dell E Roach; Clark R Andersen; Victor Z Zhu; Blake B Sparks; Linda G Phillips; Aristides P Koutrouvelis; Douglas S Tyler

doi:10.1097/01.ASW.0000803248.34424.ce

Quality Improvement Intervention Bundle Using the PUPPIES Acronym Reduces Pressure Injury Incidence in Critically Ill Patients

Adv Skin Wound Care. 2022 Feb 1;35(2):102-108. doi: 10.1097/01.ASW.0000803248.34424.ce.

Authors

Jillian M McLaughlin¹, Jacquelynn P Tran, Samee A Hameed, Dell E Roach, Clark R Andersen, Victor Z Zhu, Blake B Sparks, Linda G Phillips, Aristides P Koutrouvelis, Douglas S Tyler

Affiliation

¹ Jillian M. McLaughlin, MD, is Attending Physician, Seton Plastic & Hand Surgery, Austin, Texas, United States. At the University of Texas Medical Branch, Galveston, Texas, Jacquelynn P. Tran, MD, is Resident, Plastic Surgery, Department of Surgery; Samee A. Hameed, BS, is Medical Student; and Dell E. Roach, MSN, RN, CNML, is Surgical Intensive Care Unit Nurse Manager, Department of Anesthesiology. Clark R. Andersen, MS, is Statistician, MD Anderson Cancer Center, Houston, Texas. At the University of Texas Medical Branch, Victor Z. Zhu, MD, is Resident, Plastic Surgery, Department of Surgery; Blake B. Sparks, MD, is Resident, Plastic Surgery, Department of Surgery; Linda G. Phillips, MD, FACS, is Chair, Plastic Surgery, Department of Surgery, Aristides P. Koutrouvelis, MD, is Surgical Intensive Care Unit Director, Department of Anesthesiology; and Douglas S. Tyler, MD, FACS, is Chair, Department of Surgery. Acknowledgments: The authors thank Nicholas Lombana, MD, for assistance in translating the Spanish version of the educational patient pamphlet; Steve Schuenke, graphic artist/photographer, for assistance in formatting and printing visual tools, educational pamphlets, and the pressure injury prevention manual for quality improvement intervention bundle; and Mary A. Hill, CWOCN, University of Texas Medical Branch Wound, Ostomy, and Continence Nurse for providing information on the pressure injury prevention products available. This study was supported with institutional grant funding from the University of Texas Medical Branch 2016 President's Cabinet Award, "Impacting Community Health through Pressure Ulcer Prevention," awarded to Dr McLaughlin and Mrs Roach. The authors have disclosed no other financial relationships related to this article. Submitted February 8, 2021; accepted in revised form March 18, 2021.

PMID: 35050918
DOI: 10.1097/01.ASW.0000803248.34424.ce

Abstract

Objective: To assess whether a quality improvement bundle focusing on prevention is effective in reducing pressure injury (PI) incidence or costs or delaying PI onset.

Methods: A combined retrospective/prospective cohort study was performed at an academic tertiary care ICU on all patients admitted with a length of stay longer than 48 hours and Braden scale score of 18 or less. Following retrospective data collection (preintervention), a multimodal quality improvement bundle focusing on PI prevention through leadership initiatives, visual tools, and staff/patient education was developed, and data were prospectively collected (postintervention).

Results: Statistical and cost analyses were performed comparing both cohorts. A total of 930 patients met the study inclusion criteria (preintervention, n = 599; postintervention, n = 331). A significant decrease in PI incidence was observed from preintervention (n = 37 [6%]) to postintervention (n = 7 [2%], P = .005). This led to a predicted yearly cost savings of $826,810. Further, a significant increase in time to PI occurrence was observed from preintervention (mean, 5 days) to postintervention (mean, 9 days; P = .04). Staff were compliant with the bundle implementation 80% of the time.

Conclusions: Implementation of the quality improvement bundle focused on multimodal PI prevention in critically ill patients led to a significant reduction in PI incidence, increased time to PI occurrence, and was cost-effective.

MeSH terms

Critical Illness*
Humans
Incidence
Pressure Ulcer*
Prospective Studies
Quality Improvement*
Retrospective Studies