HAPI Reduction: A Three-Year Story

The study was done in a 585 bed, level 1 trauma center located in Dallas. The hospital is located in the south-west area of the city. Patients from several different ethnic backgrounds come to this hospital for care. Not only does the hospital care for trauma patients but also is the home of transplant patients, a spine and neuro institute and heart center. In fiscal year (FY) 2014, the hospital had a record number of hospital acquired pressure injuries (HAPIs). There were 81 HAPIs hospital wide. This was a 64% increase from the previous year. The intensive care unit (ICU) had the highest number totaling 48 HAPIs in 2014. Multiple prevention interventions were initiated hospital wide the following fiscal year with a focused intent on the ICU. In FY 2015 the ICU had decreased to 19 HAPIs. By the end of FY 2016 HAPIs had reduced to 10 and at the end of FY 2017 only 4 HAPIs were documented. Hospital-wide reduction varied from floor to floor; however, the ICU had the most significant decrease of 50% every year for 3 years. Prevention interventions included but were not limited to: Two-hour turning schedule; leadership rounds; usage of turning and positioning system; usage of offloading wedges; usage of hydrocellular foam dressings over high risk areas and bony prominences to reduce friction, shear and pressure; early mobilization; increase utilization of skin care products and an increase in both formal and informal education of the staff, patients and patients families. In addition, in the ICU, 50% of the nurses during this three-year period became critical care certified nurses. With the use of these interventions and a multi-disciplinary approach, HAPIs in the ICU were reduced by 89% and 79% hospital wide over a three-year period.