A Systemic Overhaul of Hospital-Acquired Pressure Injury Prevention: How Innovation and Accountability Drove Culture Change and Improved Outcome Drastically in a University Medical Center

Background: 266-bed university medical center (Hosp-A). Hospital-acquired pressure injury (HAPI) prevalence rate (HAPI-PR) Fiscal year (FY) 2013 annual average of 6.89% (ranked sixth percentile of national benchmark).

Goal/ Purpose: Review and enhance current organizational pressure injury (PI)prevention program (PIP) to decrease HAPI-PR to improve > 75th percentile of national benchmark annual average.

Practice Innovation:

Foster Awareness:

Promote hospital-wide awareness of HAPI through transparency of data and progress of PI prevention (PIP) measures. Present outcomes to all department leaders and in organizational meetings regularly. Post results in each unit monthly.

Encourage leadership accountability: 

Inter-professional involvement in PIP. Immediate notification of confirmed HAPI to respective unit leaders, physicians, and ancillary teams. Require unit leaders to attend monthly PI prevalence survey day (PIPSD).  

Empower bedside-staff and patients:

1. Update skin care guideline: include EBP prevention and treatment.
2. Revise staff mandatory class: emphasize PIP rather than treatment. Include EBP interventions and pertinent case studies. Convert to interactive format (hands-on activities, demonstrations, bedside scenarios).
3. Establish 2 RN-skin assessment during admission, transfer, and upon discovery of PI.
4. Eliminate adult diapers.
5. Implement progressive mobility.
6. Upgrade support surfaces.
7. Strengthen skin champions (SC).
8. Introduce immediate bedside HAPI huddle.
9. Launch unit-based HAPI peer-review.
10. Cultivate Patient/family involvement in skin care plan.
11. Conduct certified wound, ostomy and continence nurse (CWOCN) consults with primary nurse at bedside.

Expand PIPSD:   

Organized by CWOCN and SC. PIPSD switch to monthly from quarterly. Pre and post survey meetings to discuss HAPI and HAPI prevention. HAPI peer-review and presentation by SC.

Enhance CWOCN Role:

Lead PIP program. Monitor HAPI incidence and HAPI-PR monthly.  Develop and promote continuing improvement processes.

Partner with community:

Inform local Skilled nursing facilities and homehealth agencies of up-to-date PIP.

Outcomes:

HAPI-PR average of 0.4% from 2015-2017 (ranked 88th^th percentile of national benchmark).