Tele–Intensive Care Unit Collaboration to Decrease Pressure Injuries: A Quality Improvement Project

Abstract

Background Critically ill patients may have pressure injuries upon admission, increasing the need for nursing care and resources. Local Problem An increase in pressure injuries during the COVID-19 pandemic required implementation of 2-nurse skin assessments for pressure injury identification and prevention. Methods A quality improvement initiative incorporating tele–intensive care unit (tele-ICU) nurses and wound, ostomy, and continence nurses using camera technology in collaboration with bedside intensive care unit nurses was conducted in 3 intensive care units within a multi-institutional health care system from 2021 through 2023. Sites included an academic medical center and 2 community hospitals. The team implemented the following bundle: (1) tele-ICU nurses provided second skin assessments, (2) tele-ICU and bedside intensive care unit nurses reviewed pressure injury prevention measures on admission, and (3) tele-ICU nurses documented pressure injuries. Customized daily dashboards and automated reporting were implemented. Crude data descriptive analysis and segmented regression analysis were used. Results For 4723 admissions, 2-nurse skin assessment compliance increased from 46.9% during the 9-month preimplementation period to 80.8% during the 18-month postimplementation period, showing that compliance increased by 72.3%. Overall, 1153 pressure injuries were identified on intensive care unit admission or transfer, a mean of 20.6 per month before implementation and 64.1 per month after imple-mentation. In the segmented regression analysis, the number of pressure injuries identified as present on admission significantly increased after implementation (P = .02). Conclusion Integrating tele-ICU nurses, bedside intensive care unit nurses, and wound, ostomy, and continence nurses with camera technology increased compliance with 2-nurse assessments, leading to identification of present-on-admission pressure injuries, prompt treatment, and preventive interventions.