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critical care, education, ICU, pressure injury, prevention, quality improvement



  1. McLaughlin, Jillian M. MD
  2. Tran, Jacquelynn P. MD
  3. Hameed, Samee A. BS
  4. Roach, Dell E. MSN, RN, CNML
  5. Andersen, Clark R. MS
  6. Zhu, Victor Z. MD
  7. Sparks, Blake B. MD
  8. Phillips, Linda G. MD, FACS
  9. Koutrouvelis, Aristides P. MD
  10. Tyler, Douglas S. MD, FACS


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.