Tele-Intensive Care Unit Collaboration to Decrease Pressure Injuries: A Quality Improvement Project

Area of Science:

• Critical Care Medicine
• Nursing
• Quality Improvement

Background:

• Critically ill patients frequently present with pressure injuries on admission, increasing care demands.
• The COVID-19 pandemic exacerbated the incidence of pressure injuries, necessitating enhanced identification and prevention strategies.

Purpose of the Study:

• To evaluate the impact of a two-nurse skin assessment protocol on pressure injury identification and prevention in intensive care units.
• To assess the effectiveness of integrating tele-intensive care unit (tele-ICU) nurses with bedside nurses and wound, ostomy, and continence nurses.

Main Methods:

• A quality improvement initiative was conducted in three intensive care units from 2021 to 2023.
• The protocol involved tele-ICU nurses performing second skin assessments, collaborative review of prevention measures, and documentation of pressure injuries using camera technology.
• Data analysis included crude descriptive statistics and segmented regression analysis.

Main Results:

• Two-nurse skin assessment compliance increased from 46.9% to 80.8% post-implementation, a 72.3% improvement.
• The number of identified pressure injuries present on admission significantly increased after implementation (P = .02).
• Mean monthly identified pressure injuries rose from 20.6 to 64.1.

Conclusions:

• The integrated approach using tele-ICU, bedside ICU, and wound care nurses with camera technology significantly improved compliance with two-nurse assessments.
• This led to increased identification of present-on-admission pressure injuries, enabling prompt treatment and preventive interventions.
• The study highlights the success of collaborative, technology-assisted nursing interventions in managing pressure injuries in critical care settings.