Facility Acquired Pressure Injuries (FAPIs) in Acute Care 2009 to 2016

Glenda B. Kelman, PhD, ACNP-BC, Nursing, The Sage Colleges and St. Peter's Health Partners, Troy, NY and Mary Anne Jadlos, MS, ACNP-BC, CWON, Skin, & Ostomy Nursing Nursing Service, St. Peter's Health Partners - Albany Memorial, Samaritan and St. Mary's Hospitals, Troy, NY
The purpose of this study was to investigate Facility Acquired Pressure Injuries (FAPIs) in two community hospitals from 2009 to 2016.  

Pressure Injuries (PrIs) are a major health care issue in the U.S. impacting approximately three million adults annually. Facility Acquired Pressure Injury (FAPI) incidence rates range from 0% to 53.4%. Approximately 15% of elderly patients develop a PrI in the first week of hospitalization. U.S. FAPI treatment costs range between $37,800 to $70,000/ulcer. Engaging nurses in prevalence studies facilitates commitment, ownership and empowers nurses to "Champion" quality cost-effective care in preventing FAPIs.  

After IRB approval, a review of 22 FAPI prevalence studies from 2009 to 2016 was conducted based on 3,310 patients in two hospitals. A Root Cause Analysis (RCA) was conducted for each FAPI.  

The FAPI rate ranged from 0.8% to 4.7% during the seven year period. The average FAPI rate excluding Stage 1 was 1.99% which is LOWER than the National 2015 FAPI rate excluding Stage 1 of 2.5%. The FAPI rate has DECREASED during the seven year period. Root cause analyses revealed common FAPI sites (coccyx, sacrum and heels) consistent with current research. 

Limitations included a convenience sample. The FAPI rate has potential for error due to reliance on documentation in the medical record, and if patients with FAPIs are counted more than once in sequential measurement. 

FAPI prevalence data is essential in analyzing rates and trends including Root Cause Analysis (RCA) to improve evidence-based practice in PrU prevention and management, and to reduce costs. In addition, retrospective and concurrent data can be used to establish institutional benchmarks to align with National “Best Practices” to reduce FAPUs. Research implications include continued quarterly data collection of FAPI prevalence in both hospitals and further data analysis examining relationships between Braden risk scores, demographic variables and FAPIs.