Background: In a systematic review, hospitalized patients face a significant burden of pressure injuries, (pooled prevalence=12.8%; hospital-acquired rate=8.4%) with superficial pressure injuries, (st..
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Background: In a systematic review, hospitalized patients face a significant burden of pressure injuries, (pooled prevalence=12.8%; hospital-acquired rate=8.4%) with superficial pressure injuries, (stages I and II), predominantly affecting sacrum, heels, and hips.
Local Problem: In a 36-bed progressive care unit in a non-profit hospital in the Midwest, a significant increase in Hospital-Acquired Pressure Injuries (HAPIs) was observed, predominantly heel-acquired injuries in bedridden patients.
Method: The purpose of this quality improvement project was to decrease the number of HAPIs. To achieve this, a weekly audit was established, monitoring immobile patients for over 24 hours. A unit-developed protocol, the "Bedrest Checklist", featuring essential preventive measures including applying protective foam to the coccyx, wearing heel protection boots, using suitable incontinence products, seeking nutrition consultation, and undertaking bi-hourly patient repositioning was developed and implemented. Documentation guidance was provided. Audits involved a detailed review of patients' hospital stay. Adherence was incentivized via a recognition program.
Results: During a 15-week audit, there was a significant reduction in HAPIs, with only one (n=1) instance compared to nine (n=9) in 2022. Documentation of patient turns also saw substantial improvement, rising from 11% to 49.5%. Since project completion, only one (n=1) HAPI has been reported, indicating a projected yearly average of 2.2. Data suggests an overall decrease in HAPIs of 75%.
Conclusion: Promoting evidence-based practices for bed ridden patients contributes to improvements in nurse sensitive indicators including HAPI.
Implications for Practice: The implementation of a unit-specific "bedrest checklist" standardizes care for bedridden patients, reducing HAPI by offering clear care guidelines. Positive reinforcement systems nurture a patient safety culture, while strategically placed visual reminders ensure adherence to care steps. Collectively, these strategies improve patient outcomes promoting best practices in HAPI prevention.
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