Date of Award

2026

Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chair

Lenora Smith

Committee Member

Elizabeth Pickney

Subject(s)

Bedsores--Prevention, Patients--Positioning, Bedsores--Nursing, Intensive care nursing

Abstract

Pressure injuries are the most common issue for patients admitted to intensive care. Pressure injuries present significant challenges for the healthcare management team, cause pain for the patient, and increase healthcare costs. The implementation of a comprehensive pressure injury prevention bundle in the medical intensive care units at Ben Taub Hospital was a quality improvement initiative that evaluated the impact of training nurses to adhere to intervention bundles when managing patients. In the first quarter of 2024, eight patients developed pressure injuries, ranging from stage I to stage IV, including deep tissue injuries, exceeding the National Database of Nursing Quality Indicators mean for a Magnet hospital. The care bundle included the Braden Scale assessment, skin assessment documentation, and nutritional consultation for patients identified as being at risk. Application of a protective dressing, repositioning every two hours, and monitoring clock utilization was included in overall bundle compliance. The project occurred over a 12-week period involving 62 patients, all of whom had a Braden Scale score of 18 or less on admission. The patients were from different racial backgrounds with various medical diagnoses such as COPD, renal failure, sepsis, and COVID. The nurses recruited for the project were from different educational and racial backgrounds, with ages ranging from 22 to 60 years. Pre- and post-knowledge assessments were administered to nurses. In the pre-assessment, 31 nurses scored below 80%, while only 19 scored above 90%. Following the intervention, results improved significantly, with only four nurses scoring below 80%, and 46 scoring above 90%. Compliance with the care bundle also demonstrated substantial improvement after the intervention. Pre-intervention compliance with the full bundle was 62%, increasing to 95% post-intervention. Project results indicated that the implementation of the pressure injury prevention bundle reduced the incidence of hospital-acquired pressure injuries in critically ill patients on the project unit. The number of patients with pressure injuries decreased from eight before the intervention to four after implementation, representing a 50% reduction. This reduction in pressure injuries results in improved quality of life, reduced pain, shorter hospital stays, and lower costs for both patients and hospitals.

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Available for download on Thursday, November 04, 2027

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