Reducing Hospital Acquired Pressure Injuries on an Advanced Care Unit

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) are increasing nationwide. HAPIs are a negative outcome of hospitalization and these conditions are not eligible for reimbursement, resulting in billions of dollars of healthcare costs to hospitals. HAPI rates were noted to climb on an advanced care unit in a community-based hospital in the Pacific Northwest. In order to reduce this patient harm event, the nurse manager partnered with the nursing professional development specialist to lead a HAPI prevention quality improvement plan. PURPOSE: To decrease HAPI rates on the Advanced Care Unit. METHODS: The nurse manager conducted a deep dive on all HAPI events on the unit and identified a wide variance of scores assigned using the evidence-based practice tool for assessing risk for skin breakdown: the Braden Scale. The nurse manager required all nurses who were involved in the care of patients who developed a HAPI in 2020 to complete a facility-specific HAPI investigation tool. Each nurse was responsible to meet one on one with the manager to review the information together. Next, all nurses working on the advanced care unit were administered a survey containing two standardized patient cases and were required to assign a Braden score based on each case. Nurses then completed an educational module detailing best practice on assessing skin breakdown risk and appropriate nursing interventions for preventing injury. In addition, nurses were required to complete a two-RN skin check utilizing a half-sheet paper tool passed on from nurse to nurse on all patients newly admitted or transferred to the unit and to conduct a 2-RN skin assessment during each shift report on patients with a Braden less than 18 or receiving any supplemental oxygen. Finally, three months after the interventions, nurses repeated the cases studies and assigned appropriate Braden scores. The nurse manager monitored for changes to unit HAPI rates as well as improvement in nursing accuracy for assigning the Braden score. RESULTS: After implementation of the nursing education, the unit HAPI rate reduced to zero. The unit has sustained this rate for one year. In addition, nursing ability to assign appropriate Braden scores greatly improved. Results from case studies and quality outcomes were shared with staff. CONCLUSIONS: Best practice interventions can greatly improve nursing ability to identify patients who are high-risk for pressure-related skin injury and appropriately intervene. Ensuring that nurses have proper training and confidence to assign an appropriate Braden score and implement corresponding clinical actions may be a first step to reducing patient harm related to HAPI\u27s. IMPLICATIONS FOR PRACTICE: Clinical nurses may benefit from receiving educational in-services on prevention of HAPI\u27s. In addition, active support from nursing leadership and professional development specialists to enhance routine surveillance of skin health may assist with sustaining positive change in the acute care nursing setting.https://digitalcommons.psjhealth.org/prov_rn_conf_all/1015/thumbnail.jp