(P74) We've Got Your Back: Using a Unit HAPI Committee to Achieve 862 Days Without a Reportable Pressure Injury

Abstract Section 1: Basis of inquiry: Due to the aggressive nature of pediatric oncology treatment and the myriad of complications that can occur, many patients often face prolonged hospitalizations and an increased risk of hospital acquired pressure injuries (HAPI). It was identified that our patients are at special risk of HAPIs due to the distinct care we provide (end-of-life, blood and cellular transplant, etc.). With a monthly hospital wide skin injury prevention survey already in place, it was decided that this could serve as an opportunity to create a culture of proactivity in preventing pressure injuries.

Abstract Section 2: Purpose/Objectives: The objective of this clinical practice project was to identify patients at high risk of pressure injury and prevent the development of reportable HAPIs (stage 3, 4 or unstageable) in our oncology population.

Abstract Section 3: Methods: To accomplish our goal of preventing pressure injuries, our unit’s nurse-driven HAPI committee, who participates in the hospital-wide monthly skin survey, broadened our work and education with staff to occur all month long, instead of just on the day of the survey. Committee members communicated with each other and our unit clinical nurse specialists to identify patients at high risk of pressure injury (patients who are immobile, full care, end of life, post a prolonged ICU stay, and with multiple or problematic medical devices). Committee members (colloquially known as “skin champs”) collaborated with the bedside nurse to provide education and recommend interventions, including placing prophylactic Mepilex, implement turning schedules, utilizing the Comfort Glide system or ceiling lift, and off-load bony prominences.

Abstract Section 4: Findings or Outcomes: Education with these bedside nurses was effective in that staff began to identify opportunities for HAPI prophylaxis and implementing these interventions independent of skin champ involvement. Skin champs became known as reliable resources for all skin concerns, and staff frequently sought their input. Whenever skin champs were in the charge or resource nurse role on the unit, they made it a priority to check in on patients identified as high risk for HAPIs, which often included our patients receiving end of life care. As a result, skin champs were able to correct off-loading techniques, Mepilex placement, and even identify and protect early pressure injuries from advancing to later stages. As an exemplar of this work, we had three patients with prolonged stays (ranging from 6 months to 1.5 years) admitted with pre-existing pressure injuries and limited mobility whose wounds healed, and they never developed additional pressure injuries. This diligence in protecting our vulnerable population resulted in 862 days without a reportable pressure injury on the inpatient oncology unit