Document Type

DNP Project

Publication Date


Faculty Advisor

Sylvie Rosenbloom DNP, APRN, FNP-BC, CDCES

Practice Mentor

Paula Bowley MSN, RN, CCRN


Significance and Background: Pressure injury rates have increased within the critical care population. Pressure injuries are known to increase pain, infection risk, length of stay leading to decreased quality of life. Thermal imaging cameras highlight areas of hypoperfusion, allowing staff to target these areas as high likelihood to progress to a pressure injury. Foam dressings have been shown to help decrease pressure injury acquisition. Prevention methods should utilize evidence-based skin care bundles and focus on known information and target areas. Combining knowledge from thermal cameras, foam dressings, turning every two hours and accurate use of documentation scale (Braden Scale), a clinical tool used to assess degree of risk for pressure injury can help providers decrease pressure injury rates.

Purpose: Educate nursing staff on the importance of pressure injury prevention and implement a new skin bundle to prevent hospital acquired pressure injuries and update the current skin care protocol.

Methods: The methodology used for this QI project the Plan-Do-Study-Act (PDSA) was from the Institute for Healthcare Improvement. A total of three PDSA cycles were completed. Thermal imaging indicating hypoperfusion to the coccyx triggers the initiation of the new skin care bundle protocol. Use of thermal camera is required within first 24 hours of patient’s admission. Patients admitted were thermal imaged, if hypoperfusion was seen skin care bundle was implemented, foam dressing applied, turns Q2, documentation of hypoperfusion, foam dressing application, turns, and Braden Scale.

Outcomes: A total of 202 patients were seen during the implementation period. Protocol implementation during initial cycle was 100%, but then dropped to 38% which led to a cycle adjustment, thus increasing implementation to 71% still below target goal of 80% set by the DNP student. However, final adjustments made resulted in 98% implementation rate. During the project implementation 86% of the HAPI’s acquired were a result of failure to initiate protocol or incomplete protocol initiation.

Discussion: Implementation of full skin care protocol (all criteria) lead to decreased HAPI’s. Early identification of hypoperfusion on critically ill patients helps target areas of high-pressure injury risk. Next steps are presenting findings to staffing committee and board of directors in April to possibly implementation the new skin bundle on hospital floors. Discussion on how to effectively do so with only one thermal camera are also being assessed.


A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

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Nursing Commons



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