(EBP-015) Breaking the Cycle: Long Term Care's New Pressure Injury Prevention Paradigm

Introduction: Pressure injury (PI) development in long-term care (LTC) facilities remains a significant and costly issue in the United States, disproportionately impacting a vulnerable population. Despite being identified by the Centers for Medicare and Medicaid Services (CMS) as largely preventable and a key indicator of quality care, the prevalence of PIs remains unacceptably high. While many LTC facilities implement some preventive measures, the consistent application of comprehensive, up-to-date evidence-based guidelines is lacking in this care setting.

Methods: A nurse practitioner-led quality improvement (QI) project was implemented to address pressure injury (PI) prevention using evidence-based interventions and new technology for early and accurate risk assessment. At a skilled long-term care (LTC) facility, newly admitted patients underwent visual skin inspection (VSI), Braden Scale risk assessment, and sub-epidermal moisture (SEM) scanning. A nurse-driven clinical decision tree guided additional interventions for at-risk patients, including successive SEM scanning, VSI, and risk assessments over four weeks. Evidence-based interventions included applying five-layer silicone foam dressings to bony prominences and implementing patient-specific pressure-reduction strategies.

Results: The project included 54 new patient admissions over a total duration of 18 weeks, with 108 active screening days during the implementation phase. Results demonstrated a statistically significant improvement in nurses' ability to identify newly admitted patients at risk for pressure injuries, along with increased utilization of evidence-based pressure-reduction strategies.

Discussion: Project analysis revealed a strong correlation between a multi-faceted assessment approach, a nurse-driven clinical decision tree, and a reduction in new pressure injuries among newly admitted patients. This approach demonstrates potential for successful implementation in similar settings. However, project limitations included a small sample size, time constraints, and a lack of prior studies on sub-epidermal moisture (SEM) scanning in long-term care settings.