Abstract
PURPOSE: The purpose of this quality improvement project was to determine if head immobilization, pressure redistribution for the occiput, and offloading of pressure from craniotomy incisions could be improved by utilizing fluidized positioners instead of pillows previously used as the standard of care. The second purpose was to determine cost savings for the organization.
PARTICIPANTS AND SETTING: Eight patients with head trauma and craniotomy in a surgical intensive care unit (SICU) and cardiovascular intensive care unit (CVICU) from a level 1 trauma center in the Southeast region of the United States participated over a 6-month period.
APPROACH: The project comprised educating staff including nurses, nursing assistants, supervisors, and care managers, and implementation of the head positioner from July 2018 to December 2018. Staff from the SICU and CVICU, a step-down unit, and a neurological ICU were also educated on the fluidized positioner, because patients were transferred to these units when stable. All patients who underwent craniotomy surgery were placed on the fluidized positioner postoperatively until immobilization and offloading were no longer required.
OUTCOME: During the initial 6-month evaluation period, no new pressure injuries or incisional trauma occurred in the 8 patients. The economic impact to treat one hospital-acquired unstageable pressure injury was estimated at $78,722. Because no new occipital pressure injuries occurred in the 8 patients placed on the fluidized head positioner, the hospital potentially saved $629,776.
IMPLICATION FOR PRACTICE: Findings from the project suggest that implementation of a fluidized positioner can redistribute pressure to the occiput, offload craniotomy incision sites, and prevent pressure injuries.