Education & Evaluation of Risk Factors Associated with Pressure Injuries in the Surgical Patient: A Quality Improvement Project

Abstract

Purpose. This Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to provide an educational opportunity through peer-to-peer instruction and correctly identifying risk factors associated with pressure injuries (PIs) in surgical patients. The goal was to identify knowledge gaps and improve perioperative staff knowledge and confidence in identifying risk factors associated with intraoperative-acquired pressure injuries (IAPIs) while promoting adherence to current QI practices. Background. IAPIs are a quality indicator for perioperative care. Evaluation of risk factors decreases the incidence of injury and mitigates PI treatment costs. Extrinsic and intrinsic risk factors in surgical patients increase the incidence of IAPIs, which can be identified within 48-72 hours after a surgical procedure in this highly susceptible population. Methods. Participants included Registered Nurses (RNs), Perfusionists, and PreOp/PACU patient care assistants (PCAs). The primary investigator (PI) sent an invitation to participate via email to (n = 57) direct-patient care perioperative staff, including an electronic recruitment flyer and disclosure statement. A pre/post-survey design incorporated a PowerPoint (Appendix E) for participants' self-education and review of information with separate pre/post-surveys (Appendix D). The PI predicted a response rate of 53% (n = 30), and pre/post-education test scores were obtained and used for statistical analysis. Results. The PI used descriptive statistics to aggregate and synthesize the data. Of the (n = 57) recruitable staff, a total of (n = 26) participants completed both the pre and post-tests, providing a 46% response rate for each test. Statistical analysis found a significant difference between the pre/post-test scores, and the PI rejected the null hypothesis (H0), stating there is no relationship between IAPI risk factor education and pre/post-test scores. Additionally, the analysis supported the alternate hypothesis (Ha), demonstrating a positive relationship between IAPI risk factor education and pre/post-test scores. Conclusions. Early identification of surgical patients’ unique risk factors by perioperative staff can increase team collaborative efforts in alleviating the incidence of IAPIs. This DNP project demonstrated that peer-to-peer education improves the knowledge of perioperative staff in correctly identifying risk factors associated with IAPIs in surgical patients, potentially reducing or preventing the number of IAPIs.