Maintaining Skin Integrity of Patients Diagnosed With SARS CoV2: A Quality Improvement Project

Abstract

PURPOSE: This purpose of this quality improvement project was to develop and evaluate a protocol (intervention bundle) designed to prevent pressure injuries in patients admitted with SARS-CoV2 and required prone positioning. PARTICIPANTS AND SETTING: The sample comprised 267 patients aged 18 years and older, who were admitted with SARS-CoV2 and required prone positioning. Their age ranged from 32 to 76 years; a majority (54%, n = 145) were intubated. The study setting was an urban 220 bed acute care hospital in Northern California. APPROACH: A task force comprising the quality management team, certified wound care nurses and nursing leadership used the plan-do-study-act cycle completed a quality improvement project designed for preventing pressure injuries among patients admitted with SARS-CoV2 and managed with prone positioning, either with or without mechanical ventilation. The five phases of the quality improvement project were protocol development, education, implementation, and evaluation. Data collection period for this quality improvement was between April 2020 and August 2020. Outcomes were evaluated using descriptive statistics. OUTCOMES: Sixteen patients (6%) experienced a total of 25 pressure injuries. The time between initial prone placement and change back to supine positioning was 24 hours (36 ± 12 hours). The most common pressure injuries were deep tissue injuries, primarily over the heels and sacrum. IMPLICATIONS FOR PRACTICE: This protocol maintained the skin integrity of 94% of a group critically ill patients admitted with SARS-CoV2 and managed by prone positioning.