Other Titles
TEAMS Bundle: Implementation of a Pressure Injury Prevention Bundle in a Medical Intensive Care Unit [Title Slide]
Abstract
Background: Hospital-acquired pressure injuries (HAPIs) are considered preventable yet remain prevalent in intensive care units (ICUs), where critically ill patients face increased risk due to immobility, hemodynamic instability, and complex care needs. This quality improvement (QI) project aimed to evaluate whether implementing a pressure injury prevention bundle (TEAMS) would improve compliance with preventive measures and staff attitudes toward HAPI prevention in a medical ICU.
Methods: A pre-post intervention design was conducted in a 17-bed medical ICU at a tertiary academic hospital. The TEAMS bundle included five components: Turn teams, Education, daily Assessments, a multidisciplinary approach, and daily Skin care. The intervention was implemented over 12 weeks following a 4-week education phase. Compliance data were collected via weekly chart audits (113 pre-implementation charts; 204 post-implementation charts). Staff attitudes were measured using the Staff Attitude Scale (SAS) before and after implementation. Statistical analyses included Mann-Whitney U tests for HAPI incidence, paired t-tests for SAS scores, and control charts for compliance trends.
Results: After the implementation, compliance improved for all parts of the bundle: the Braden scale (38% to 64%), skin assessments (70% to 73%), two-hour turns (76% to 81%), daily skin care (71% to 78%), and provider documentation (59% to 62%) (p < 0.001). SAS scores increased significantly from a mean of 39 (SD = 4.9) to 46 (SD = 3.88) (p < 0.001), indicating more positive attitudes toward HAPI prevention. However, the number of HAPI cases did not go down; there were 3 injuries before the implementation and 17 during it, with one case being an outlier because the patient was medically unstable for the whole TEAMS bundle to be put into place.
Conclusion: Implementing the TEAMS bundle improved staff attitudes and compliance with preventive measures but did not reduce HAPI incidence. Barriers such as inconsistent patient turning and staffing constraints may have contributed to persistent injury rates. Future efforts should focus on sustaining compliance, addressing turning adherence, and exploring targeted interventions to reduce HAPIs in high-acuity settings. However, an improved attitude toward PI prevalence is an improvement, a step in the right direction to eliminate hospital-acquired pressure injuries.
Notes
Reference list included in attached slide deck.
Sigma Membership
Alpha Epsilon
Lead Author Affiliation
Emory University, Atlanta, Georgia, USA
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Acute Care, Pressure Ulcers, Preventive Health Services, Intensive Care Units, Attitudes of Medical Personnel
Recommended Citation
Woods, Elizabeth L., "Effect of a Pressure Injury Prevention Bundle on Compliance and Staff Attitudes in a Medical ICU" (2026). International Nursing Research Congress (INRC). 307.
https://www.sigmarepository.org/inrc/2026/presentations_2026/307
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-09-25
Effect of a Pressure Injury Prevention Bundle on Compliance and Staff Attitudes in a Medical ICU
Toronto, Ontario, Canada
Background: Hospital-acquired pressure injuries (HAPIs) are considered preventable yet remain prevalent in intensive care units (ICUs), where critically ill patients face increased risk due to immobility, hemodynamic instability, and complex care needs. This quality improvement (QI) project aimed to evaluate whether implementing a pressure injury prevention bundle (TEAMS) would improve compliance with preventive measures and staff attitudes toward HAPI prevention in a medical ICU.
Methods: A pre-post intervention design was conducted in a 17-bed medical ICU at a tertiary academic hospital. The TEAMS bundle included five components: Turn teams, Education, daily Assessments, a multidisciplinary approach, and daily Skin care. The intervention was implemented over 12 weeks following a 4-week education phase. Compliance data were collected via weekly chart audits (113 pre-implementation charts; 204 post-implementation charts). Staff attitudes were measured using the Staff Attitude Scale (SAS) before and after implementation. Statistical analyses included Mann-Whitney U tests for HAPI incidence, paired t-tests for SAS scores, and control charts for compliance trends.
Results: After the implementation, compliance improved for all parts of the bundle: the Braden scale (38% to 64%), skin assessments (70% to 73%), two-hour turns (76% to 81%), daily skin care (71% to 78%), and provider documentation (59% to 62%) (p < 0.001). SAS scores increased significantly from a mean of 39 (SD = 4.9) to 46 (SD = 3.88) (p < 0.001), indicating more positive attitudes toward HAPI prevention. However, the number of HAPI cases did not go down; there were 3 injuries before the implementation and 17 during it, with one case being an outlier because the patient was medically unstable for the whole TEAMS bundle to be put into place.
Conclusion: Implementing the TEAMS bundle improved staff attitudes and compliance with preventive measures but did not reduce HAPI incidence. Barriers such as inconsistent patient turning and staffing constraints may have contributed to persistent injury rates. Future efforts should focus on sustaining compliance, addressing turning adherence, and exploring targeted interventions to reduce HAPIs in high-acuity settings. However, an improved attitude toward PI prevalence is an improvement, a step in the right direction to eliminate hospital-acquired pressure injuries.
Description
Hospital-acquired pressure injuries (HAPIs) remain common in ICUs despite being preventable. This project tested the TEAMS bundle, which includes Turn Teams, Education, Assessments, Multidisciplinary Approach, and Skin Care over 12 weeks while also evaluating staff attitudes towards PI prevention. While TEAMS Bundle Compliance and staff attitudes improved significantly, HAPI incidence did not decrease. Plans include researching PI interventions for high-acuity patients and PI compliance.