Device –Related Hospital Acquired Pressure Ulcers (HAPU)

Prevalence of device-related HAPU is a problem in the acute care setting causing pain, loss of function, infection, extended hospital stay and increased costs. In spite of best practice strategies pressure ulcer prevalence and incidence continues with up to 35 percent related to  medical devices. Identifying HAPU is a high priority, however, definition of device-related HAPU is unclear and there is high variation of reporting across facilities.

Following the Iowa Model for Evidence-Based Practice to Promote Quality Care, triggers were examined and a task force was created. After a thorough review of current evidence and clinical practice recommendations, the task force developed an evidence-based position statement, which included a definition for device-related HAPU. Content of the statement was reviewed by experts and appropriate revisions were made.

This position statement provides guidance and structure to accurately identify and report device-related HAPU. Specifically, clinicians are able to distinguish between pressure ulcers resulting from an external medical device versus nonmedical device. Practice recommendations include: device-related HAPU are identified using the evidenced-based definition, device-related HAPU are classified and staged according to the recommendations of NPUAP and NDNQI, and these recommendations are used when reporting device-related HAPU. 

This concise and evidence-based position statement supports appropriate identification and reporting of device-related pressure ulcers. Through the intentional focus on pressure ulcer prevention and evidence-based practice, HAPU rates have shown sustainable improvement and declined more than 33 percent from 2011 and 2012. In addition, critical care nurses received funding from AACN to study improvement strategies related to device-related HAPU.