Title : Champions for change: A CSICU pressure injury reduction initiative
Abstract:
Problem Statement: Hospital-acquired pressure injuries are areas of skin and underlying tissue damage caused by prolonged pressure. In the US, incidence in intensive care units ranges from 16.2% to 23.8%, due to factors such as high patient acuity, immobility, use of sedatives and vasopressors, and dependence on medical devices
1. These injuries delay recovery and prolong hospital stays by an average of 19 days
2. Contributing to an estimated $26.8 billion in annual treatment costs in the United States
Purpose: The purpose of this project was to reduce the number of unit-acquired sacral pressure injuries in the Cardiothoracic Surgical Intensive Care Unit. Nursing staff were assigned as “skin champions” and tasked with ensuring 2-hour repositioning of all patients on the unit.
Approach: This unit-based quality improvement initiative was undertaken in a 29-bed Cardiothoracic Surgical Intensive Care Unit (CSICU) at The Mount Sinai Hospital in New York, NY. From February 27th to July 27th, 2025, the intervention centered on the implementation of the "skin champion” role. This skin champion role is assigned in addition to a nurse’s patient assignment and the duties are rotated amongst staff each shift. They ensured availability for turning every two hours, thereby reinforcing adherence to evidence-based pressure injury prevention protocols. A standardized checklist was developed to capture the status of each repositioning attempt, including whether it was completed with assistance from the skin champion, deferred by the primary nurse, or not performed.
Results: Our project started on February 27th, 2025. We looked at the number of unit-acquired sacral pressure injuries for a five-month period before implementation and found 16. In a five-month period after the implementation of the skin champion, there were 2 unit-acquired sacral pressure injuries. This is an 87% reduction in unit-acquired sacral pressure injuries.
Conclusion and Implications for Clinical Practice: The skin champion initiative proved to be highly successful. This unit-based quality improvement project improved patient outcomes as the number of unit-acquired sacral pressure injuries decreased. Additionally, the project created an opportunity for increased communication amongst staff. High risk patients were identified and discussed in a pre-shift huddle. With this increased awareness, nurses collaborated to ensure that patients were turned and repositioned every two hours. This project suggests that skin champions help decrease pressure injury occurrences and create a culture of teamwork and collaboration.
