References
Perioperative pressure injury prevention: National Pressure Injury Advisory Panel root cause analysis toolkit 3.0
Abstract
Objectives:
Operating room-related pressure injuries (ORPI) are particularly challenging to examine for several reasons. Time in the OR is often a distinct event within the hospitalisation, and discovery of an ORPI may occur between several hours and up to 5 days postoperatively. The National Pressure Injury Advisory Panel (NPIAP) first developed a root cause analysis (RCA) toolkit in 2017 as a systematic strategy for investigating the root causes of facility-acquired pressure injury (PI). The purpose of this 2021 RCA toolkit update was to address an expanded investigation of medical device-related PIs (MDRPIs), both inside and outside the OR, as well as the specific PI prevention issues of the perioperative area.
Methods:
Clinicians have been using the 2017 toolkit as a basis for ongoing quality improvement tracking, since it provides more accurate information than data extractions from patient health records. A small working group consisting of NPIAP board and panel members developed investigative questions to identify the ORPI root causes and compliance with best practices for the entire perioperative experience.
Results:
Action items are linked to evidence-based recommendations from the NPIAP/European Pressure Ulcer Advisory Panel/Pan Pacific Pressure Injury Alliance 2019 International Guideline and the Association of PeriOperative Registered Nurses (AORN) Guidelines for Perioperative Practice. A multidisciplinary clinician guide was also developed to identify practice gaps and to compile the information into an action plan for staff education and/or process improvement.
Conclusion:
The updated NPIAP RCA toolkit provides mechanisms for investigating, compiling and trending data as a basis for data-driven quality improvement. Using the enhanced investigative tools, the root causes of both MDRPIs and ORPIs can be better understood to target efforts to reduce their occurrence.
The National Pressure Injury Advisory Panel (NPIAP) is an independent not-for-profit professional organisation dedicated to the prevention and management of pressure injuries (PI). Since 1986, NPIAP has been a leading voice in PI prevention and management through the development of educational materials, publication of white papers, support of research and public policy advocacy. In 2009, the NPIAP collaborated with the European Pressure Ulcer Advisory Panel (EPUAP) to publish Prevention and treatment of pressure ulcers: clinical practice guideline (CPG).1 The Pan Pacific Pressure Injury Alliance (PPPIA) joined the NPIAP and EPUAP to develop the second edition in 2014.2 Using an explicit scientific methodology, the CPG (now in its third edition) provides evidence-based recommendations for the prevention and treatment of PIs for an international audience.3
However, PIs still occur, despite the best efforts of clinicians, and aetiologies are often multifactorial. In 2017, NPIAP developed and published a root cause analysis (RCA) toolkit based on the 2014 CPG to assist clinicians to determine root causes and develop effective quality improvement (QI) strategies. This original version of the toolkit covered the standard or non-surgical hospitalisation episode of care.4 In 2019, based on increased recognition of the perioperative-related PI within the continuum of care, NPIAP added an updated version of its RCA toolkit that included new perioperative-specific questions, new medical device-related pressure injury-specific questions and hyperlinks to relevant excerpts from the 2019 International Guideline for targeted education to support quality improvement activities.5
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