Quality Improvement Intervention Bundle Using the PUPPIES Acronym Reduces Pressure Injury Incidence in Critically Ill Patients

Jillian M. McLaughlin, Jacquelynn P. Tran, Samee A. Hameed, Dell E. Roach, Clark R. Andersen, Victor Z. Zhu, Blake B. Sparks, Linda G. Phillips, Aristides P. Koutrouvelis, Douglas S. Tyler

Research output: Contribution to journalArticlepeer-review


OBJECTIVE To assess whether a quality improvement bundle focusing on prevention is effective in reducing pressure injury (PI) incidence or costs or delaying PI onset. METHODS A combined retrospective/prospective cohort study was performed at an academic tertiary care ICU on all patients admitted with a length of stay longer than 48 hours and Braden scale score of 18 or less. Following retrospective data collection (preintervention), a multimodal quality improvement bundle focusing on PI prevention through leadership initiatives, visual tools, and staff/patient education was developed, and data were prospectively collected (postintervention). RESULTS Statistical and cost analyses were performed comparing both cohorts. A total of 930 patients met the study inclusion criteria (preintervention, n = 599; postintervention, n = 331). A significant decrease in PI incidence was observed from preintervention (n = 37 [6%]) to postintervention (n = 7 [2%], P =.005). This led to a predicted yearly cost savings of $826,810. Further, a significant increase in time to PI occurrence was observed from preintervention (mean, 5 days) to postintervention (mean, 9 days; P =.04). Staff were compliant with the bundle implementation 80% of the time. CONCLUSIONS Implementation of the quality improvement bundle focused on multimodal PI prevention in critically ill patients led to a significant reduction in PI incidence, increased time to PI occurrence, and was cost-effective.

Original languageEnglish (US)
Pages (from-to)102-108
Number of pages7
JournalAdvances in Skin and Wound Care
Issue number2
StatePublished - Feb 1 2022
Externally publishedYes


  • ICU
  • critical care
  • education
  • pressure injury
  • prevention
  • quality improvement

ASJC Scopus subject areas

  • Dermatology
  • Advanced and Specialized Nursing


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