Supplementing pressure injury root cause analysis with wearable sensor data: a case series

BACKGROUND AND SIGNIFICANCE: Pressure injury root cause analyses (RCA) are complex investigations into patient history, diagnoses, nursing assessments and interventions. Patient repositioning history is often poorly documented[1] and doesn’t provide valuable insight about patient’s movement history. This case series reviews repositioning data derived from a wearable sensor system[2] for 3 critical care patients with hospital-acquired pressure injuries (HAPI) during their hospitalization.         

CASE 1: 43-yo female admitted for cardiogenic shock developed a coccygeal Stage 2 PrI 33 days after admission. Patient was monitored for 694 hours. Five days post admission, patient’s minimum lateral turn angle was reduced to 15-degrees, indicating difficulty tolerating full lateral turns. Mean turn adherence was 89%. Patient refused 24 repositioning attempts for 49 care hours. RCA determined pressure injury to be unavoidable due to patient’s severity of illness. 

CASE 2: 72-yo female with sepsis and renal failure developed coccygeal DTI 7 days after post admission. Patient was monitored for 375 care hours. Turn adherence before and after DTI discovery was 90% and 88% respectively. The main reason for delayed turns was dialysis. Patient spent 51% of time in lateral positions. RCA determined PrI was related to fecal management device.

CASE 3: 77-yo male developed coccygeal Unstageable PrI 27 days after admission for CHF/COPD. Patient was monitored for 619 hours with mean turn adherence of 95% and 22% in supine position. Fecal management system was in place for 15 days prior to PrI an deemed as contributing factor.

CONCLUSION: In all cases, data showed patients were turned per facility protocol. Objective data derived from actual patient movements is a valuable addition for RCA.