Intensive Care Unit Team
Providence Alaska Medical Center (Anchorage)
As the chaos of COVID-19 descended upon the Providence Alaska Medical Center Intensive Care Unit (PAMC ICU), it brought with it a vicious companion - hospital acquired pressure injuries (HAPIs). With effort and ingenuity, the caregiver team successfully fought back, and in a matter of weeks, reduced HAPI incident rates by more than 80 percent.
As the pandemic raged, the team began to search for solutions for treating HAPIs on patients' anterior body surfaces, especially their face, chest, and hips; they acquired new knowledge through peer-reviewed literature and found practical, evidence-based guidance through the National Pressure Injury Advisory Panel (NPIAP). The ICU team adopted NPIAP’s helpful recommendations and modified them to further enhance processes and procedures to increase patient and caregiver safety.
One of the first important modifications came when team nurses and respiratory therapists collaborated to discontinue use of traditional endotracheal tube holders in favor of tape, making the process easier for caregivers to manage and maintain. Front-line nurses came up with one creative solution after another to address patient injuries, including assembling “to go packs” in advance, making all the necessary materials and supplies readily available to caregivers at a moment’s notice along with checklists and other job aids, including a “Proning Tips and Tricks” tip sheet.
To safely prone patients is often challenging even for the most skilled caregivers. Because COVID-19 patients were isolated in negative pressure rooms, access to ceiling lifts was limited, making the procedure even more difficult. Extensive practice in perfecting the technique eventually enabled PAMC ICU caregivers to prone patients in seamless unison without the supervision of physicians.
The measurable results of these efforts are profound. After intervention began in July 2020, the 100 percent incident rate plunged to lows of 14 percent in November 2020 and 18 percent in December 2020. Anecdotally, the HAPIs that were experienced were significantly less severe than those initially experienced.
Recently, the PAMC ICU team had an opportunity to reach beyond Providence to share insight and expertise with caregivers at Central Peninsula General Hospital. After one of its patients was transferred to PAMC ICU for proning therapy, caregivers in Anchorage mentored caregivers in Soldotna via a Zoom web conferences with hopes of reducing or eliminating the need for further transfers.
This success truly tells a story of teamwork and dedication. Every team member actively collaborated and contributed. Without exception, skills, knowledge, experience, ideas and positive energy came from every corner – from nurses and respiratory therapists to aids and physicians. Congratulations to the team!