Guiding Change: Evaluating the Impact of Nurse Leader Rounding on Pressure Injury Incidence

Introduction: The prevalence of pressure injuries (PIs) is highest among critical care settings, with these patients being 4 times more likely to develop an advanced stage PI. These patients are at increased risk of skin breakdown due to hemodynamic instability and the increased use of medical devices. This project aimed to determine how a leadership-led PI prevention auditing tool impacts the incidence of unit-acquired pressure injuries (UAPIs) in the medical intensive care unit (MICU.)


Methods: An experimental design was utilized with retrospective data analysis to compare the prior 8 months before this auditing tool was initiated. The audit was employed on twice daily rounds by a MICU nursing leadership member which included a nursing supervisor, nursing manager or clinical nurse specialist. The auditing tool included bedside rounding and patient chart review. The nurse leader engaged in bedside rounding to ensure patients were on the appropriate bed type, that heel boots were in place, verifying the usage of only one underpad beneath the patient, and that a wedge or pillow was being used for turning and repositioning. Additionally, they assessed skin integrity under devices attached to the head and face and ensured appropriate padding under these devices. Specific chart review metrics using the auditing tool included assessing the turning and positioning documentation of the previous shift, determining if wound care orders were entered for patients with a documented PI, and if a photo was taken of PIs within the last 24 hours. Deficient areas identified were resolved immediately onsite.


Results: From initiation of the rounding tool in April 2025 to July 2025 the PI incidence rate was 0.90% (n= 556.) This demonstrates a decrease in the PI incidence rate from December 2024 to March 2025 which was 3.35% (n= 538) and also a decrease from August 2024 to November 2024 which was 2.26% (n= 532) prior to the use of this rounding tool. UAPIs attributed to end of life were excluded.


Conclusions: Study findings support that leadership-led collaboration in PI prevention shows a positive impact on quality improvement and patient outcomes. The conclusions suggest that the use of a nurse leader PI prevention rounding tool has a positive impact on the PI incidence in the MICU.