Purpose: Hospital-acquired pressure injuries (HAPIs) are a preventable occurrence which can lead to poor quality of life and increased morbidity and mortality. In this newly established medical-surgical unit, the majority of nursing clinicians were recent nursing school graduates. From April 2017 to March 2019, this unit had four separate incidences of HAPIs, exceeding the goal of zero hospital-acquired pressure injury. A gap was identified that revealed a structure and process was missing regarding pressure injury identification and prevention. The advanced beginner requires an organized process to encourage development of clinical decision-making and autonomy within the nursing scope of practice.
Description: In the adult-medical surgical patient population (P), would implementation of a standardized two nurse skin assessment and pressure injury prevention/management plan (I), in comparison to the current practice (C), decrease the time from risk identified to prevention implementation and overall reduction in HAPI incidence (O)?
A pre-/post-implementation questionnaire was provided to nursing staff to assess perceived comfort level of recognizing risk and utilizing appropriate skin breakdown prevention measures. Clinical nurse skin champions were identified and provided continual staff education with daily huddle discussions to ensure practice consistency. A standardized, two-RN assessment (4 eyes) tool was used to emphasize early recognition, prevention, and/or treatment of pressure injury. A novice nurse was paired with an experienced nurse to encourage collaborative critical thinking, development of improved integumentary assessment skills, and construction of a personalized pressure injury patient care plan.
Outcomes: For eight months after implementation, the unit continues to sustain zero incidence of HAPI. The clinical nursing staff has embraced the two RN (4 eyes) skin assessment process and remains engaged in development of individualized skin breakdown and prevention measures. Documentation of interventions or preventative measures decreased from 6.08 hours (baseline) to 2.5 hours. Post-implementation survey results revealed an increased confidence in skin assessment, documentation, and care plan development. Standard work provided the staff with the necessary tools to formulate an individualized, evidence-based plan of care.