Purpose: Preventing hospital-acquired pressure injuries (HAPIs) in health care has been a challenge for many years and aging patient populations and increasing comorbidities and acuities have intensified these challenges2. With an estimated 60,000 patient deaths and 17,000 lawsuits filed every year related to HAPIs, we understood the importance of focusing on reducing HAPIs in our organization3. Despite implementing multiple strategies over many years, we continued to see HAPIs develop during patients’ hospital stays. From May 2018 to December 2018, one unit in our hospital identified seven patients that had developed HAPIs during their hospital stay. With an average of one patient per month developing a HAPI, it was clear we needed to examine and revise our practices. In January 2019, an interdisciplinary team implemented two-person skin assessments, twice weekly, for patients with a Braden score of 18 or less. Unfortunately, this strategy was not enough to prevent patients from developing HAPIs, and from January 2019 to June 2020, we had 15 additional patients develop HAPIs.
Description: The lack of results from the two-person skin assessments gave the interdisciplinary team an opportunity to re-look at practices. With collaboration and input from leaders, in July 2020 this team implemented a validation tool. On Mondays and Thursdays, the lead nurse completed a shift safety checklist highlighting the patients with a Braden score of 18 or less. If skin assessments were not completed and signed off, the leaders did real-time follow-up with staff. This tool was implemented as a part of a HAPI prevention program that was developed by staff and leaders on this unit.
Evaluation/outcomes: Shifting from a responsive focus to a preventative focus while assessing and mitigating the barriers and challenges at the patient and staff levels has helped us develop and implement a HAPI prevention program that is comprehensive with attainable and sustainable goals.2 When this project was first launched, we implemented two-person skin assessments that were to be completed twice per week. We quickly learned that this was not enough to be successful. This led to the creation of the validation process, which allowed leaders to hold staff accountable to the expectations. HAPI prevention is now part of the unit's culture and staff remain engaged in the prevention process. Experts predict that with a 50% reduction in HAPIs organizations will save an average of five million dollars a year3 and these numbers reinforced our need for a HAPI prevention program that included on admission two-person skin assessments, twice weekly two-person skin assessments, and a validation tool with real-time follow-up. Since full implementation of the HAPI prevention program, we have improved skin assessment completion through validations from less than 50% compliance to over 90% compliance. In addition to skin assessment completions, we have improved patient outcomes with a reduction in HAPIs from 24 in three years to zero patients developing HAPIs, April 2021 to date, resulting in over 404 days without a stage one or two HAPI and 2769 days without a stage three or four HAPI.
Evidence-based references 1. Alderden, J., Cowan, L., Dimas, J. B., Chen, D., Zhang, Y., Cummins, M., & Yap, T. L. (2020). Risk factors for hospital-acquired pressure injury in surgical critical care patients. American Journal of Critical Care, 29(6), e128-e134. https://www.doi.org/10.4037/ajcc2020810 2. Amon, B. A., David, A. G., Do, V. H., Ellis, D. M., Portea, D., Tra, P., & Lee, B. (2019). Achieving 1,000 days with zero hospital-acquired pressure injuries on a medical-surgical telemetry unit. MedSurg Nursing 28(1), 17-21. 3. Vitale, N. A., & Dzioba, D. A. (2021). How hospitals benefit by preventing hospital-acquired pressure injuries. Healthcare Financial Management Magazine.