Reducing pressure injuries in critically ill patients by using a patient skin integrity care bundle (InSPiRE).
OBJECTIVE
To test an interventional patient skin integrity bundle, the InSPiRE protocol, for reducing pressure injuries in critically ill patients in an Australian adult intensive care unit.


METHODS
Before and after design: patients receiving the intervention (InSPiRE protocol) were compared with a similar control group who received standard care. Data collected included demographic and clinical variables, skin assessment, presence and stage of pressure injuries, and score on the Sequential Organ Failure Assessment (SOFA).


RESULTS
Overall, 207 patients were enrolled, 105 in the intervention group and 102 in the control group. Most patients were men (mean age, 55 years). The groups were similar on major demographic variables (age, SOFA scores, intensive care unit stay). Cumulative incidence of pressure injuries was significantly lower in the intervention group (18.1%) than in the control group (30.4%) for skin injuries ( [Formula: see text], P = .04) and mucous injuries (t = 3.27, P ≤ .001). Significantly fewer pressure injuries developed over time in the intervention group (log rank = 11.842, df = 1, P ≤ .001) and intervention patients had fewer skin injuries (> 3 pressure injuries/patient = 1/105) than did control patients (> 3 pressure injuries/patient = 10/102; P = .02).


CONCLUSIONS
The intervention group, receiving the InSPiRE protocol, had a lower cumulative incidence of pressure injuries, and fewer and less severe pressure injuries that developed over time. Systematic and ongoing assessment of the patient's skin and risk for pressure injuries as well as implementation of tailored prevention measures are central to preventing pressure injuries.
Fiona Coyer is a professor, School of Nursing, Queensland University of Technology, Kelvin Grove, and the Intensive Care Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. Anne Gardner is a professor of nursing, School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, Dickson, Australia. Anna Doubrovsky is a project manager, School of Nursing, Queensland University of Technology. Rae Cole is a clinical nurse, Metro North Transition Care Program, North Lakes Health Precinct, Queensland, Australia. Frances Mary Ryan, Craig Allen, and Greg McNamara are clinical nurses, Intensive Care Department, Royal Brisbane and Women's Hospital. f.coyer@qut.edu.au.
Fiona
F
Coyer
Fiona Coyer is a professor, School of Nursing, Queensland University of Technology, Kelvin Grove, and the Intensive Care Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. Anne Gardner is a professor of nursing, School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, Dickson, Australia. Anna Doubrovsky is a project manager, School of Nursing, Queensland University of Technology. Rae Cole is a clinical nurse, Metro North Transition Care Program, North Lakes Health Precinct, Queensland, Australia. Frances Mary Ryan, Craig Allen, and Greg McNamara are clinical nurses, Intensive Care Department, Royal Brisbane and Women's Hospital.
Anne
A
Gardner
Fiona Coyer is a professor, School of Nursing, Queensland University of Technology, Kelvin Grove, and the Intensive Care Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. Anne Gardner is a professor of nursing, School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, Dickson, Australia. Anna Doubrovsky is a project manager, School of Nursing, Queensland University of Technology. Rae Cole is a clinical nurse, Metro North Transition Care Program, North Lakes Health Precinct, Queensland, Australia. Frances Mary Ryan, Craig Allen, and Greg McNamara are clinical nurses, Intensive Care Department, Royal Brisbane and Women's Hospital.
Anna
A
Doubrovsky
Fiona Coyer is a professor, School of Nursing, Queensland University of Technology, Kelvin Grove, and the Intensive Care Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. Anne Gardner is a professor of nursing, School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, Dickson, Australia. Anna Doubrovsky is a project manager, School of Nursing, Queensland University of Technology. Rae Cole is a clinical nurse, Metro North Transition Care Program, North Lakes Health Precinct, Queensland, Australia. Frances Mary Ryan, Craig Allen, and Greg McNamara are clinical nurses, Intensive Care Department, Royal Brisbane and Women's Hospital.
Rae
R
Cole
Fiona Coyer is a professor, School of Nursing, Queensland University of Technology, Kelvin Grove, and the Intensive Care Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. Anne Gardner is a professor of nursing, School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, Dickson, Australia. Anna Doubrovsky is a project manager, School of Nursing, Queensland University of Technology. Rae Cole is a clinical nurse, Metro North Transition Care Program, North Lakes Health Precinct, Queensland, Australia. Frances Mary Ryan, Craig Allen, and Greg McNamara are clinical nurses, Intensive Care Department, Royal Brisbane and Women's Hospital.
Frances Mary
FM
Ryan
Fiona Coyer is a professor, School of Nursing, Queensland University of Technology, Kelvin Grove, and the Intensive Care Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. Anne Gardner is a professor of nursing, School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, Dickson, Australia. Anna Doubrovsky is a project manager, School of Nursing, Queensland University of Technology. Rae Cole is a clinical nurse, Metro North Transition Care Program, North Lakes Health Precinct, Queensland, Australia. Frances Mary Ryan, Craig Allen, and Greg McNamara are clinical nurses, Intensive Care Department, Royal Brisbane and Women's Hospital.
Craig
C
Allen
Fiona Coyer is a professor, School of Nursing, Queensland University of Technology, Kelvin Grove, and the Intensive Care Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. Anne Gardner is a professor of nursing, School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, Dickson, Australia. Anna Doubrovsky is a project manager, School of Nursing, Queensland University of Technology. Rae Cole is a clinical nurse, Metro North Transition Care Program, North Lakes Health Precinct, Queensland, Australia. Frances Mary Ryan, Craig Allen, and Greg McNamara are clinical nurses, Intensive Care Department, Royal Brisbane and Women's Hospital.
Greg
G
McNamara
D000328:Adult; D000368:Aged; D001315:Australia; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D003668:Pressure Ulcer / Q000517:prevention & control*