Authors (including presenting author) :
Shiu YH, Hui YC, Wong LY
Affiliation :
Department of Cardiothoracic Surgery, Queen Mary Hospital
Introduction :
Extremely low perfusion cardiac patients are exposed to unique potential risk factors for pressure injury development. As the increasing number of mechanical circulatory support patients and their prolonged ICU stay make the advanced nursing knowledge necessary to prevent pressure injury. Therefore, proactive team approach is a must to integrate a unique multidisciplinary plan for those extra high risk patients.
Objectives :
To coach and facilitate staff to work proactively in pressure injury prevention for extremely low perfusion cardiac patients.
Methodology :
A pressure injury team with 5 designated staff was formed in April 2018. Lecture and quiz were given to colleagues for reinforcement of knowledge on pressure injury prevention. Besides, the general conditions of all CTSD ICU patients were reviewed every week. Prophylactic foam on sacral area is given proactively to extra high risk patients. Early mobilization training from passive cycling on bed to standing and walking is custom made. Tailor made cannula binder and pressure relieving cushions are assisted for mobilization. Close observation on nutritional status and favorite food is encouraged if possible. Keep warm is necessary to maintain good perfusion for patients with extracorporeal circuit. Weekly photo record when skin condition worsens so that the trend of pressure injury changes can be traced.
Result & Outcome :
There are 65 staff working in CTSD ICU and all of them passed the quiz. The special targeted group is (n=21, 32%) with less than 5 years RN experience and less than 3 years ICU experience. (n=18, 86%) claimed that they have not had any knowledge about pressure injury prevention for extremely low perfusion cardiac patients before graduation. All (n=21, 100%) strongly agreed that proactive pressure injury team can facilitate them in pressure injury prevention and they appreciated about the weekly clinical photo taking. Moreover, they strongly believed (n-5, 24%) and slightly believed (n=16, 76%) that proactive team approach can reduce the incidence of pressure injury formation and stop worsening the pressure injury. To conclude, an organized proactive team approach can ease the workload of staff in the stressed working environment since advanced nursing knowledge and skills are needed to provide multidisciplinary care on those extremely low perfusion cardiac patients. Advanced pressure injury prevention is a long run program in CTSD ICU, therefore regular updated knowledge on staff is recommended.
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