Implementation of an Educational Pressure Injury Tool in the Perioperative Setting: A Quality Improvement Project

Abstract

The purpose of this Doctorate of Nursing Practice quality improvement (QI) project was to improve knowledge and communication of pressure injury (PrI) risk factors among pre-operative, intra-operative, and post-operative registered nurses (RNs) in a Southwestern Level 1 trauma hospital. The goal was to augment the perioperative RNs' knowledge on PrI risk factorsand increase communication of PrI risk factors of adult surgical patients during perioperative RN handoff. The administration of an identical pre-test/post-test assessed knowledge improvement. A run-chart was used to evaluate the frequency of PrI risk factor communication among perioperative RNs. Objectives included: 1) Administer a pre-test to assess perioperative RNs' baseline knowledge on PrI risk factors; 2) Provide a 20-minute, evidence-based in-service presentation to increase perioperative RNs' knowledge on PrI risk factors; 3) Evaluate data of the implementation of PrI risk assessment and communication forms for adult surgical patients during four one-week Plan-Do-Study-Act (PDSA) cycles; and 4) Administer a post-test to assess knowledge acquisition. Of the 19 RNs who completed both pre-tests and post-tests, the majority were female (N = 16, 84.2%), 52.6% (N = 10) had their Bachelor of Science in Nursing; while 42.1% (N = 8) had their Associate Degree in Nursing. A total of 52.3% (N = 10) of the RNs had less than 5 years of experience at this facility, 61.1% (N = 11) have not had previous education about PrI risk factors, and 94.7% (N = 18) have never heard of the Munro Scale© prior to the QI project. This QI project helped improve post-test scores in 14 out of 20 items that were considered risk factors of perioperative PrI development. Collected data were analyzed using the paired t-test and chi-square tests. According to the paired sample t-test between pre-test and post-test scores (N = 19), the difference was not statistically significant (t18 = 1.72, p = 0.10), but indicated an improvement of 2.1 points (SD = 5.33) in PrI risk knowledge. According to the evaluation survey, 100% (N = 19) of RN participants believed that the educational presentation either partially met, met, or exceeded their expectations. The majority of participants (94.7%, N = 18) believed that after this project, they would be more likely to increase communication of perioperative PrI risk factors to the RN of the next level of care. The majority (94.7%, N = 18) also reported that they would be more likely to incorporate appropriate precautions in preventing PrIs in surgical patients after this project. Although the National Pressure Ulcer Advisory Panel does not currently promote a specific surgery-specific PrI risk assessment tool, the Association of Perioperative Registered Nurses (AORN) includes the Munro Pressure Ulcer Risk Assessment Scale for Perioperative Patients© (Munro Scale©) in their Prevention of Perioperative Pressure Injury Tool Kit (Association of periOperative Registered Nurses [AORN], n.d.).The CMUNRO SCALE© served as an educational tool for perioperative RNs in learning surgery-specific PrI risk factors and is recommended for wider implementation and dissemination.