"Happy Hiney Program" or how we reduced our Hospital Acquired Pressure Injuries by over 80% on our Magnet Journey

Melanie Hardy, BSN, RN, CWOCN, Denton Regional Medical Center, Denton, TX

In December 2009 our  acute care hospital implemented a comprehensive Pressure Injury Prevention Program, titled the "Happy Hiney Program" after  identifying 101 HAC (hospital aquired condition)pressure injuries. Focus was on changing the staff misconception that HAC pressure injuries were  the WOC nurse's responsibilty and the importance of maintaining skin integrity based on HAC pressure injuries being viewed as an indicator of quality, the associated  financial impact and risk of litigation. Nursing Administration supported  the formation of RN driven protocols to reduce HAC pressure injuries based  on evidence based research (SOE=A) from NPUAP and EPAP that  focused on combating the 4 extrinsic factors that contribute to HAC pressure injuries:

  •  shearing
  •  pressure 
  •  friction 
  •  microclimate


1. Identify at risk patients with a Braden score of 18 or less, reassess every shift and document  findings.

2. Implement  "Happy Hiney Program" hospital wide, on admission by :

  •  Applying  silcone 5 layer dressing to sacrum, label with "smiley faces" for prevention (no skin breakdown) or "sad faces" (impaired skin ) .  
  •  Use of a static air overlay mattress for pressure redistribution.

3. Licensed staff completed the NDNQI pressure ulcer tutorial, for 1.5 CEU's.

4. Developed Wound Care Council (WCC) chaired by WOC nurse, composed of Skin Champions from units that meets monthly for prevention of  HAC pressure injuries, review products ,protocols and  complete quarterly Prevalence Studies.

3. Developed wound care protocols  linked with  product photos located in supply rooms for reference, products bins were color coded.

4. Mandatory Skills Fair for staff  on pressure injury staging and documentation, correct  products use.  


December 2009  =101 HAC pu rate

December 2010=59 HAC pu rate

December 2011=23 HAC pu

December 2012 =23 HAC pu

December 2013 =10 HAC pu

December 2014=16 HAC pu

December 2015 =9 HAC pu

These findings show over 80% sustained reduction in HAC pressure injuries  and prompted support  of the  prevention program, and greatly reduced cost of HAC pressure injuries and bed rentals. The protocols were critical in our  achievment of our Magnet designation, and the results have been replicated by other facilities.