A Novel Trilayer Human Amnion/chorion/intermediate Layer Membrane* Use for Chronic Venous Leg Ulcer Case

Introduction: Venous leg ulcers (VLU) affect 1% to 2% of the popu- lation and the incidence increases with age affecting approximately 4% of those older than 65 years.1 Because VLUs have a high chronicity and recurrence rate and slow healing time, they accounts for 80%2 of all leg ulcers. VLUs are known to impact a patient’s quality of life from pain, swelling, and exudate leakage, which leads to psychological distress including embarrassment, social isolation, depression, and anxiety. VLUs impact the inflicted person’s mobility and daily activities due to the limitations from the wound and associated symptoms. Per CMS3 and CAMPs4 guidelines, after four weeks of standard of care, with less than 50% surface area reduction, wounds, including VLUs, are consid- ered chronic. Current recommended guidelines suggest that advanced therapies including placental-based allografts be considered for chronic wounds.3,4 LHACM, a new, novel tri-layer placental-based allograft intended for deeper and complex wounds, is presented in this case study. We submit a Venous Leg Ulcer (VLU) case where a novel trilayer human Amnion/Chorion/Intermediate Layer Membrane* (LHACM), was em- ployed to support the chronic wound closure. Methods: A 70-year-old polymorbid female presented with a chronic VLU. The chronic VLU wound was treated with standard of care and eight LHACM applications, which adheres to the new LCD allograft allowance. Results: The chronic VLU wound closed in 3 months. Discussion: This case represents foundational evidence support use of LHACM, a novel trilayer human Amnion/Chorion/Intermediate Layer Membrane* treatment. Building evidence is important to support its con- tinued use for chronic VLUs. Solutions to close chronic wounds including VLUs are needed to help these patients physically and psychologically. PI-049 (RPT-010) From Pressure to Prevention: Elevating Care in the Intensive Care Unit Julia Wyrick, BSN, RN, WCC Introduction: Sacral gluteal Hospital Acquired Pressure Injuries (HAPIs), a form of skin breakdown, commonly affect ICU patients due to decreased mobility and poor hemodynamics. HAPIs have long term effects on patients’ skin integrity, quality of life, and increase hospital costs. Literature shows turning reduces the incidence of HAPIs. Audits validate low turning compliance. Compared with traditional repositioning devices, Air Assisted Repositioning Devices (AARD’s) are more accessible for frequent patient repositioning, effectively offload the sacrum, and decrease strain to staff. Methods: This quality improvement project was implemented on a 28 bed ICU. AARD’s were acquired through clinical nurse collaboration and leader advocacy for funding. The device was trialed and feedback includ- ed ease of use for nurse workflow, including ability to keep device under patient for frequent use. Nurses received education on patient selection, positioning, and device management. Select clinical nurses were trained as super users. Pre implementation data consisted of 90 observed turn assessments. Post implementation data was collected over 6 months. Turning assessment compliance was defined as: 1) adherence to the turn- ing schedule, 2) offloading of the patient sacral gluteal region. Results: Implementation occurred in April 2024. 2024 ICU pre imple- mentation turning compliance, adherence to the turning schedule, was 54.7%; 18% of patients had sacral gluteal region offload. Post implemen- tation turning compliance was 60%; 71% of patients had sacral gluteal re- gion offload. In 2023 the ICU had 10 sacral gluteal HAPIs, six months post implementation ICU incidence decreased to one. Adjusted for time, this is an 80% reduction in sacral gluteal HAPIs in the ICU. Post implemen- tation HAPI data outperforms national mean. Estimated cost savings of $83,600. Projected annual cost savings of $167,200. Post implementation data was disseminated during unit staff meetings. Discussion: Turning compliance and offloading increased after education and implementation of AARDs, decreasing HAPI incidence and associated costs in the ICU. Nursing structural empowerment and decision-making impacted device selection, implementation, and post evaluation stages improving patient outcomes.