Date of Degree

Fall 2024

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

Abstract

  • Problem:

Heel pressure injuries (HPIs) are preventable, yet they can easily occur when policies specifically targeting heel protection are lacking. A quality improvement methodology was implemented on two intensive care units (ICUs) within an organization which involved revising existing policies to standardize practices and mitigate occurrences.

Aim of the Project:

To evaluate the effectiveness of an evidence-based protocol that utilizes Mepilex border dressings to prevent hospital-acquired HPIs in ICUs.

  • Review of the Evidence:

Across various studies, common themes emerged, notably the utilization of prophylactic Mepilex foam dressings as effective interventions specifically targeted in the ICU.

  • Project Design:

A protocol was established to prevent hospital-acquired HPIs on two ICUs. Baseline and final surveys were distributed to assess change readiness and progress. Four key process measures were analyzed from nursing documentation over eight weeks. The project utilized the Plan-Do-Study-Act (PDSA) cycle to enhance sustainable improvements. Outcomes were collected pre- and post-implementation, and Ohio Health Resources offered guidance on sustainability at the project's conclusion.

  • Intervention

Implementation of an evidenced-based protocol using the application of Mepilex border dressings to prevent HPIs.

  • Significant Findings/Outcomes

Key process measures:

Comprehensive skin assessments: Met 80% goal, both units

Use of Braden scale: Met 80% goal, both units

Application of the Mepilex border dressing: Unit A had a 12.14% and Unit B had a 26.14% compliance rate, although improvements in nursing documentation and practice occurred in some weeks.

Dressing Changes within 72 hours of Application: 0% compliance, both units.

Outcome measure:

ICU A, there was no change in the rate of hospital-HPIs, 0.3% incidence rate pre and post project implementation.

ICU B, showed a slight increase of 0.3%

Implications for Nursing

Nurses play a critical role in identifying at-risk patients and implementing strategies to prevent HPIs. To support this, healthcare organizations should establish standardized, evidence-based policies for prevention. Despite outcomes in the two ICUs, there is a clear need for broader adoption of the Mepilex Border dressing across all healthcare settings.

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