Sibley has set high goals in how patient care is provided, especially in the intensive care unit (ICU). As part of the organization’s goal to achieve a “zero-harm” ICU, the team has taken a data and evidence-based approach to reducing the incidence of hospital-acquired pressure injuries (HAPIs).

After conducting a baseline assessment, ICU nurses led performance improvement efforts to review existing standard workflows and implement a multi-faceted initiative to achieve zero HAPIs.

On the front end, the team implemented a series of changes to documentation, in coordination with the unit’s Comprehensive Unit Safety Program (CUSP) team, nurse specialists, clinical care champions, physicians, and quality and safety officers. New standard of care expectations and practices were established, including two-nurse skin assessments becoming standard practice at admission and throughout an inpatient stay.

“We need these workflows to become muscle memory,” says Jussara Gama, nurse manager of Sibley’s ICU. “We are working collaboratively to establish that hospital-acquired pressure injuries will not be a part of our ICU practice.”

The baseline assessments and development of initiatives started under the guidance of Liza Rebello, nurse manager of critical care, before Gama became the unit’s current nurse manager. Rebello says that focusing on HAPIs was an easy choice because they are widely considered a primary indicator of nursing quality practice and have a huge impact on critical care patients.  

A series of standard practices and some equipment designed to reduce exposure to moisture were introduced to remove some of the external factors that contribute to pressure injuries during a hospital stay. Chief among the practice changes was creation of the turning team, an evidence-based practice initiated by ICU nurse Jonathan Carrara. The turning team is a pre-assigned duo of either two nurses or a nurse and a technician, who rotate through the unit working together to regularly turn ICU patients and clean any soiled linens, preventing injuries from starting.

Every Wednesday, the wound team and nursing staff conduct thorough skin assessments of every patient and track that information. It’s known as Skin Integrity Wednesday.

With the onset of the pandemic, some implementation was delayed but the team is well on its way to reaching its goal.