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Recommended Citation
Kohlbrand M, Scholz T, Belin L, Moore J. Beyond the Surface: Nursing Strategies for Hospital Acquired Pressure Injury Reduction and Protocol Standardization. Quality Improvement podium presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Quality Improvement podium presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Background
Hospital-acquired pressure injuries (HAPIs) are a key nurse-sensitive indicator and a major component of the PSI-90 National Database of Nursing Quality Indicators (NDNQI) metrics. Preventing PIs are critical for enhancing patient care and reducing financial burdens, costing between $500 to $40,000 per patient.
Local Problem
Atrium Health (AH) Mercy experienced 56 HAPIs in 2022 and 67 in 2023, prompting the need for structured reduction initiatives. In 2023, the cost of treating Stages 3, 4, and Unstageable PIs averaged $14,500 each, totaling $536,500. Despite existing AH policies emphasizing prevention strategies and documentation protocols, an assessment revealed documentation gaps and inconsistent protocol awareness among staff.
Methods
An interdisciplinary team, the Pressure Injury Prevention (PIP) Squad, was formed to address gaps. Utilizing the Plan, Do, Study, Act (PDSA) Cycle and the 8-Step Problem Solving Method, the team conducted 150 chart audits and Gemba walks to compare current practices to the ideal state. The team identified four critical documentation areas: Provider Notification, Lines, Drains, and Airways (LDA) Documentation, Skin Documentation, and Nutrition Consult, which comprise the ‘HAPI Prevention Bundle’. A containment strategy was implemented to improve performance in these areas.
Results
The interventions led to significant improvements. HAPIs reduced by 11% YTD 2024, aiming not to exceed 53 total HAPIs. NDNQI performance improved, with a target of 4 of 7 units outperforming benchmarks. Compliance with 2-person skin assessment documentation was sustained above 80% YTD, a 78.4% increase from the 50% baseline. Compliance with bundle documentation improved from a baseline of 36% to 88% by April 2024.
Implications for Practice
The structured interventions and focused documentation improvements effectively reduced HAPIs. Sustained adherence to prevention protocols and accurate documentation are crucial for enhancing patient outcomes and reducing healthcare costs. This initiative serves as a model for facilities aiming to improve pressure injury prevention and documentation practices.
References
Burston, A., Miles, S.J., & Fulbrook, P. (2023). Patient and carer experience of living with a pressure injury: A meta‐synthesis of qualitative studies. Journal of Clinical Nursing, 32(13–14), 3233-3247. doi:10.1111/jocn.16431
Frances, L., Zijing, W., Bing, S., Fiona, C., & Wendy, C. (2020). The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review. International Journal of Nursing Studies, 102, 103483. doi:10.1016/j.ijnurstu.2019.103483
Kim, J., Lyon, D., Weaver, M.T., Keenan, G., & Chen, X. (2019). The role of psychological distress in the relationship between the severity of pressure injury and pain intensity in hospitalized adults. Journal of Advanced Nursing, 75(6), 1219-1228. doi:10.1111/jan.13913
Labeau, S.O., Afonso, E., & Benbenishty, J. (2021). Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: The DecubICUs study. Intensive Care Medicine, 47(2), 160-169. doi:10.1007/s00134-020-06234-9
Pittman, J., Otts, J.A., Riley, B., & Mulekar, M.S. (2022). Pressure injury prevention and management: A gap analysis using key stakeholder engagement. Journal of Wound Ostomy & Continence Nursing, 49(5), 416-427. doi:10.1097/WON.0000000000000906
Saunders, L.L., Krause, J.S., Peters, B.A., & Reed, K.S. (2010). The relationship of pressure ulcers, race, and socioeconomic conditions after spinal cord injury. The Journal of Spinal Cord Medicine, 33(4), 387-395. doi:10.1080/10790268.2010.11689717
Seibert, J., Barch, D., & Bernacet, A. (2020). Examining social risk factors in a pressure ulcer quality measure for three post-acute care settings. Advances in Skin & Wound Care, 33(3), 156-163. doi: 10.1097/01.ASW.0000651456.30210.8a
Ulutaşdemir, N., Ay, H., Göçmen, A., Uzun, S., & Kulakaç, N. (2024). Practices of patient relatives aimed at preventing pressure injuries and their experiences of coping with the burden of care: A qualitative study. Advances in Skin & Wound Care, 37(3):1-6. doi:10.1097/ASW.0000000000000104
Document Type
Oral/Podium Presentation
Publication Date
11-13-2024
Beyond the Surface: Nursing Strategies for Hospital Acquired Pressure Injury Reduction and Protocol Standardization
Background
Hospital-acquired pressure injuries (HAPIs) are a key nurse-sensitive indicator and a major component of the PSI-90 National Database of Nursing Quality Indicators (NDNQI) metrics. Preventing PIs are critical for enhancing patient care and reducing financial burdens, costing between $500 to $40,000 per patient.
Local Problem
Atrium Health (AH) Mercy experienced 56 HAPIs in 2022 and 67 in 2023, prompting the need for structured reduction initiatives. In 2023, the cost of treating Stages 3, 4, and Unstageable PIs averaged $14,500 each, totaling $536,500. Despite existing AH policies emphasizing prevention strategies and documentation protocols, an assessment revealed documentation gaps and inconsistent protocol awareness among staff.
Methods
An interdisciplinary team, the Pressure Injury Prevention (PIP) Squad, was formed to address gaps. Utilizing the Plan, Do, Study, Act (PDSA) Cycle and the 8-Step Problem Solving Method, the team conducted 150 chart audits and Gemba walks to compare current practices to the ideal state. The team identified four critical documentation areas: Provider Notification, Lines, Drains, and Airways (LDA) Documentation, Skin Documentation, and Nutrition Consult, which comprise the ‘HAPI Prevention Bundle’. A containment strategy was implemented to improve performance in these areas.
Results
The interventions led to significant improvements. HAPIs reduced by 11% YTD 2024, aiming not to exceed 53 total HAPIs. NDNQI performance improved, with a target of 4 of 7 units outperforming benchmarks. Compliance with 2-person skin assessment documentation was sustained above 80% YTD, a 78.4% increase from the 50% baseline. Compliance with bundle documentation improved from a baseline of 36% to 88% by April 2024.
Implications for Practice
The structured interventions and focused documentation improvements effectively reduced HAPIs. Sustained adherence to prevention protocols and accurate documentation are crucial for enhancing patient outcomes and reducing healthcare costs. This initiative serves as a model for facilities aiming to improve pressure injury prevention and documentation practices.
References
Burston, A., Miles, S.J., & Fulbrook, P. (2023). Patient and carer experience of living with a pressure injury: A meta‐synthesis of qualitative studies. Journal of Clinical Nursing, 32(13–14), 3233-3247. doi:10.1111/jocn.16431
Frances, L., Zijing, W., Bing, S., Fiona, C., & Wendy, C. (2020). The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review. International Journal of Nursing Studies, 102, 103483. doi:10.1016/j.ijnurstu.2019.103483
Kim, J., Lyon, D., Weaver, M.T., Keenan, G., & Chen, X. (2019). The role of psychological distress in the relationship between the severity of pressure injury and pain intensity in hospitalized adults. Journal of Advanced Nursing, 75(6), 1219-1228. doi:10.1111/jan.13913
Labeau, S.O., Afonso, E., & Benbenishty, J. (2021). Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: The DecubICUs study. Intensive Care Medicine, 47(2), 160-169. doi:10.1007/s00134-020-06234-9
Pittman, J., Otts, J.A., Riley, B., & Mulekar, M.S. (2022). Pressure injury prevention and management: A gap analysis using key stakeholder engagement. Journal of Wound Ostomy & Continence Nursing, 49(5), 416-427. doi:10.1097/WON.0000000000000906
Saunders, L.L., Krause, J.S., Peters, B.A., & Reed, K.S. (2010). The relationship of pressure ulcers, race, and socioeconomic conditions after spinal cord injury. The Journal of Spinal Cord Medicine, 33(4), 387-395. doi:10.1080/10790268.2010.11689717
Seibert, J., Barch, D., & Bernacet, A. (2020). Examining social risk factors in a pressure ulcer quality measure for three post-acute care settings. Advances in Skin & Wound Care, 33(3), 156-163. doi: 10.1097/01.ASW.0000651456.30210.8a
Ulutaşdemir, N., Ay, H., Göçmen, A., Uzun, S., & Kulakaç, N. (2024). Practices of patient relatives aimed at preventing pressure injuries and their experiences of coping with the burden of care: A qualitative study. Advances in Skin & Wound Care, 37(3):1-6. doi:10.1097/ASW.0000000000000104
Affiliations
Atrium Health Mercy