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Interdisciplinary collaboration reduces Hosptial acquired pressure injuries at A Tertiary-Level Hospital Setting
Diwakar Phuyal, MBBS; Fanru Shen, MD; Kayla Little, MSN, APRN; Mary Montague-McCown, DNP, APRN, ACNS-BC, CWOCN; Toms Augustin, MD, MPH, FACS; Eliana Ferreira Ribeiro Duraes, MD, PhD
Cleveland Clinic Foundation
2025-01-16
Presenter: Diwakar Phuyal
Affidavit:
Yes
Director Name: Raymond Isakov
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Pressure injuries significantly impact quality of life, often leading to extended hospital stays, poor prognoses, and increased mortality. Hospital-acquired pressure injuries, deemed "never events" by Medicare, pose a financial burden on healthcare institutions. Multidisciplinary efforts are crucial to prevent their occurrence and progression.
Method:
In July 2024, a multidisciplinary team began weekly case reviews and patient rounds for Stage 3 and greater hospital-acquired pressure injuries. The team, including a clinical nurse specialist, plastic surgeon, wound care fellow, advanced practice nurses, and members from nursing leadership, quality, and SQPE, collaboratively analyzed cases to identify themes in prevention, staging, and etiology. Tools like wound photography and WoundVision Scout™ were used to enhance wound evaluation accuracy and identify pressure injuries present on admission (POA). Data collected included injury stage, etiology, and attribution. The 2019 International Pressure Ulcer/Injury Guideline informed these efforts.
Results and Discussion:
Key themes included challenges in identifying POA injuries, subjectivity in staging, and the need for further research into alternate etiologies like skin failure. Nursing protocols were revised to activate the wound care team for advanced injuries and empower clinical nurses to manage less severe cases. Cadaver dissection was introduced as an educational initiative to improve understanding of skin layers and pressure injury classification.
Conclusion:
Multidisciplinary engagement standardized pressure injury staging and improved processes for reducing hospital-acquired injuries. A high-reliability approach to identifying POA injuries was critical to success.
