Patients with skin damage in intensive care units

Since 2018, our Quality Control Circle has actively participated in hospital-wide quality improvement competitions, focusing on safe care for critically ill patients with skin injuries. The project integrates a series of innovative interventions, including continuing education programs on incontinence-associated dermatitis (IAD) and pressure injuries (PI), an online role-playing game (RPG)-based learning platform, a critical skin care bundle, and a digital wound image database. These initiatives aim to strengthen nurses' knowledge, clinical competencies, and adherence to evidence-based skin care practices.
Led by nurses and supported through interdisciplinary collaboration, the program promotes standardized assessment, prevention, and management of skin injuries in critical care settings. Through continuous quality improvement efforts, the project has enhanced care quality, improved patient safety, and fostered a culture of teamwork and innovation in skin injury prevention and management.

Development of an integrated critical skin injury care bundle, incorporating facial medical device-related pressure injury prevention strategies, structured care for incontinence-associated dermatitis (IAD), and comprehensive skin care protocols.
Creation of the first role-playing game (RPG) for wound care education, which received the “Creative Excellence Award,” the only innovation award presented at the hospital-wide Quality Improvement Competition.
Integration of the Nursing Information System with the Hospital Information System to enhance clinical documentation, information sharing, and continuity of care.
Establishment of an online RPG based learning platform to strengthen nurses’ competencies in critical skin injury assessment, prevention, and management.
Implementation of specialized skin care bundles, including an IAD severity-based care kit, prophylactic foam dressings, a pressure injury prevention kit, and a surgical wound care kit.
Utilization of the IMMIS interdisciplinary collaboration platform in conjunction with a cloud-based medical photography application to create a comprehensive wound image database, facilitating clinical decision-making, knowledge sharing, and quality monitoring.
Through nurse-led interdisciplinary collaboration and continuous quality improvement efforts, these innovations have strengthened evidence-based practice, enhanced patient safety, and improved the quality of skin injury prevention and management in critical care settings.

Medical Intensive Care Unit (MICU) Service Volume and Utilization Statistics
In 2020, the MICU recorded 944 patient discharges and transfers, with an average length of stay of 6.65 days and a bed occupancy rate of 75.4%.
In 2021, the MICU recorded 900 patient discharges and transfers, with an average length of stay of 7.45 days and a bed occupancy rate of 76.2%.
In 2022, the MICU recorded 881 patient discharges and transfers, with an average length of stay of 7.90 days and a bed occupancy rate of 79.3%.
From January to June 2023, the MICU recorded 437 patient discharges and transfers, with an average length of stay of 7.86 days and a bed occupancy rate of 79.4%.
The Medical Intensive Care Unit cared for an average of 63 hospitalized patients per month.

Outcomes and Quality Performance Indicators
From 2019 to June 2023, the incidence rate of incontinence-associated dermatitis (IAD) was consistently maintained below the target benchmark of 25% each quarter.
From 2022 to June 2023, the incidence rate of pressure injuries (PI) was consistently maintained below the target benchmark of 0.5% each quarter.
From 2020 to June 2023, the incidence rate of medical device-related pressure injuries (MDRPI) remained below the target benchmark of 0.5%.
Since 2022, the hospital-acquired pressure injury rate has remained lower than the average rate among regional hospitals.
The accuracy rate of nursing staff in performing pressure injury care skills has consistently exceeded the target benchmark of 95% each month.
All 36 intensive care unit (ICU) nurses completed skin injury care training using simulation-based skills laboratory teaching aids, achieving a completion rate of 100%.
Compliance with the Critical Skin Injury Care Standards and Protocols among nursing staff reached 100%.

Key Improvement Outcomes
In 2018, the incidence rate of incontinence-associated dermatitis (IAD) was 53.7% (number of IAD cases divided by the total number of hospitalized patients with diarrhea).
In 2022, the incidence rate of pressure injuries (PI) was 1.92% (number of newly developed pressure injuries divided by total patient-days).
Nursing staff's knowledge of skin injury care increased from 88.0% to 97.0%. Competency in endotracheal tube-related skin care improved from 56.8% to98.5%, while competency in non-invasive positive pressure ventilation (NIPPV) device-related skin care improved from 67.4% to 98.1%.
Nurses' knowledge regarding the prevention and management of incontinence-associated dermatitis increased from 78.1% to 100.0%.
Wound care skill performance improved from 69.6% to 96.9%.
Accuracy in pressure injury care knowledge increased from 69.5% to 96.3%.
The average healing time for Stage 2 pressure injuries was reduced from 7 days to 5 days.
The severity of pressure injury wounds improved from Deep Tissue Pressure Injury (DTPI) , while patients' pain scores during dressing changes decreased from 6 to 2 points.

Customer Satisfaction Outcomes
An internal customer satisfaction survey conducted between August and October 2022 collected 36 valid questionnaires, achieving a 100% response rate. All satisfaction indicators scored above 92 points, with an overall average satisfaction score of 95.9 points.
An external customer satisfaction survey conducted between October and December 2022 collected 18 valid questionnaires, achieving a 100% response rate. All satisfaction indicators scored above 95 points, with an overall average satisfaction score of 98.1 points.

From 2018 to 2023, the team actively disseminated its achievements in safe critical skin injury care through national and international nursing conferences, contributing to the advancement of evidence-based practice and promoting academic excellence on a global scale.
A total of 23 nursing poster presentations were accepted and presented at domestic and international conferences.
2023 Quality Improvement Competition – Advanced Oral Presentation Category: Merit Award and Creative Excellence Award.
2020 & 2020 Golden Summit Award.
2020 Taiwan Continuous Improvement Competition, China Productivity Center (CPC) – Regional President’s Award.
2019 Quality Improvement Competition – Advanced Oral Presentation Category: Outstanding Performance Award.
20th National Healthcare Quality Award (NHQA), Taiwan Joint Commission on Hospital Accreditation – Potential Award.
29th Quality Control Circle Competition (2016), Self-Improvement Category – Bronze Tower Award for Frontline Improvement Projects.
From 2016 to 2023, the team received nine prestigious awards, demonstrating sustained excellence in quality improvement, innovation, patient safety, and critical care nursing practice.

Economic and Operational Benefits
Pressure injury dressing-related expenses were reduced by NT$275.2 per patient-day.
Hospitalization costs decreased by NT$4,595.84 per patient-day.
The average nursing time spent on wound care was reduced from 41.5 to 30.2 minutes per patient per treatment session, enhancing workforce efficiency and optimizing healthcare resource utilization.

Patients with skin damage in intensive care units

Development of an integrated critical skin injury care bundle, incorporating facial medical device-related pressure injury prevention strategies, structured care for incontinence-associated dermatitis (IAD), and comprehensive skin care protocols.
Creation of the first role-playing game (RPG) for wound care education, which received the “Creative Excellence Award,” the only innovation award presented at the hospital-wide Quality Improvement Competition.
Integration of the Nursing Information System with the Hospital Information System to enhance clinical documentation, information sharing, and continuity of care.
Establishment of an online RPG based learning platform to strengthen nurses’ competencies in critical skin injury assessment, prevention, and management.
Implementation of specialized skin care bundles, including an IAD severity-based care kit, prophylactic foam dressings, a pressure injury prevention kit, and a surgical wound care kit.
Utilization of the IMMIS interdisciplinary collaboration platform in conjunction with a cloud-based medical photography application to create a comprehensive wound image database, facilitating clinical decision-making, knowledge sharing, and quality monitoring.
Through nurse-led interdisciplinary collaboration and continuous quality improvement efforts, these innovations have strengthened evidence-based practice, enhanced patient safety, and improved the quality of skin injury prevention and management in critical care settings.

Medical Intensive Care Unit (MICU) Service Volume and Utilization Statistics
In 2020, the MICU recorded 944 patient discharges and transfers, with an average length of stay of 6.65 days and a bed occupancy rate of 75.4%.
In 2021, the MICU recorded 900 patient discharges and transfers, with an average length of stay of 7.45 days and a bed occupancy rate of 76.2%.
In 2022, the MICU recorded 881 patient discharges and transfers, with an average length of stay of 7.90 days and a bed occupancy rate of 79.3%.
From January to June 2023, the MICU recorded 437 patient discharges and transfers, with an average length of stay of 7.86 days and a bed occupancy rate of 79.4%.
The Medical Intensive Care Unit cared for an average of 63 hospitalized patients per month.

Outcomes and Quality Performance Indicators
From 2019 to June 2023, the incidence rate of incontinence-associated dermatitis (IAD) was consistently maintained below the target benchmark of 25% each quarter.
From 2022 to June 2023, the incidence rate of pressure injuries (PI) was consistently maintained below the target benchmark of 0.5% each quarter.
From 2020 to June 2023, the incidence rate of medical device-related pressure injuries (MDRPI) remained below the target benchmark of 0.5%.
Since 2022, the hospital-acquired pressure injury rate has remained lower than the average rate among regional hospitals.
The accuracy rate of nursing staff in performing pressure injury care skills has consistently exceeded the target benchmark of 95% each month.
All 36 intensive care unit (ICU) nurses completed skin injury care training using simulation-based skills laboratory teaching aids, achieving a completion rate of 100%.
Compliance with the Critical Skin Injury Care Standards and Protocols among nursing staff reached 100%.

Key Improvement Outcomes
In 2018, the incidence rate of incontinence-associated dermatitis (IAD) was 53.7% (number of IAD cases divided by the total number of hospitalized patients with diarrhea).
In 2022, the incidence rate of pressure injuries (PI) was 1.92% (number of newly developed pressure injuries divided by total patient-days).
Nursing staff's knowledge of skin injury care increased from 88.0% to 97.0%. Competency in endotracheal tube-related skin care improved from 56.8% to98.5%, while competency in non-invasive positive pressure ventilation (NIPPV) device-related skin care improved from 67.4% to 98.1%.
Nurses' knowledge regarding the prevention and management of incontinence-associated dermatitis increased from 78.1% to 100.0%.
Wound care skill performance improved from 69.6% to 96.9%.
Accuracy in pressure injury care knowledge increased from 69.5% to 96.3%.
The average healing time for Stage 2 pressure injuries was reduced from 7 days to 5 days.
The severity of pressure injury wounds improved from Deep Tissue Pressure Injury (DTPI) , while patients' pain scores during dressing changes decreased from 6 to 2 points.

Customer Satisfaction Outcomes
An internal customer satisfaction survey conducted between August and October 2022 collected 36 valid questionnaires, achieving a 100% response rate. All satisfaction indicators scored above 92 points, with an overall average satisfaction score of 95.9 points.
An external customer satisfaction survey conducted between October and December 2022 collected 18 valid questionnaires, achieving a 100% response rate. All satisfaction indicators scored above 95 points, with an overall average satisfaction score of 98.1 points.

From 2018 to 2023, the team actively disseminated its achievements in safe critical skin injury care through national and international nursing conferences, contributing to the advancement of evidence-based practice and promoting academic excellence on a global scale.
A total of 23 nursing poster presentations were accepted and presented at domestic and international conferences.
2023 Quality Improvement Competition – Advanced Oral Presentation Category: Merit Award and Creative Excellence Award.
2020 & 2020 Golden Summit Award.
2020 Taiwan Continuous Improvement Competition, China Productivity Center (CPC) – Regional President’s Award.
2019 Quality Improvement Competition – Advanced Oral Presentation Category: Outstanding Performance Award.
20th National Healthcare Quality Award (NHQA), Taiwan Joint Commission on Hospital Accreditation – Potential Award.
29th Quality Control Circle Competition (2016), Self-Improvement Category – Bronze Tower Award for Frontline Improvement Projects.
From 2016 to 2023, the team received nine prestigious awards, demonstrating sustained excellence in quality improvement, innovation, patient safety, and critical care nursing practice.

Economic and Operational Benefits
Pressure injury dressing-related expenses were reduced by NT$275.2 per patient-day.
Hospitalization costs decreased by NT$4,595.84 per patient-day.
The average nursing time spent on wound care was reduced from 41.5 to 30.2 minutes per patient per treatment session, enhancing workforce efficiency and optimizing healthcare resource utilization.

Target Population

Description

Key Highlights

Service Data

Featured Outcomes

Safety Outcomes

Satisfaction

International Achievements

Benefits and Impacts

Bundle Care for ICU Skin Injury