Target Zero: Prevention of Hospital Acquired Pressure Injuries

Background Information:  Hospital acquired pressure injuries (HAPIs) result in medical complications and additional costs.    The aim of this project was to translate evidence-based knowledge into prevention implementation with data capture for performance measurement.  

Objectives of Project: Reduce all reportable HAPIs (Stage 3 and 4) to zero by providing:

• Best care for pressure injuries by implementing prevention measures and utilizing prevention products.
• Education of pressure injury management, treatment, and prevention.
• Improvement to intra-structure processes for pressure injury monitoring.

Process of Implementation:  A pressure injury risk assessment tool and a morning report of all pressure injuries (PI) allowed the Wound, Ostomy, Continence (WOC) team to track high risk patients and those with wounds.  Daily tracking of HAPIs is discussed to assure patients are followed and needed resources, such as nutrition consults for early identification of dietary needs, can be provided.  Skin care management guidelines for moisture associated skin damage (MASD) and a post-tracheostomy insertion care order set to prevent skin breakdown for medical device related pressure injuries (MDRPI) prevention were implemented.  The Pressure Injury Prevention and Skin Care (PIPSC) committee collaborated with respiratory services on the conversion of respiratory masks to a softer, silicone mask. We established special support surface protocols for patients who were “found down” or sustained a hip fracture.  Prevention devices and collaboration with physical therapy were utilized for high risk patients related to prolonged sitting.

Statement of Successful Practice: On April 10, 2014 we achieved 150 days without a reportable HAPI. On March 20, 2016 we celebrated 626 days of no reportable HAPIs.  In FY 2016/FY 2017, we sustained our goal.

Implication for Nursing: WOCNs continue to lead best practice initiatives, coordination of quality metrics, and provide direct patient care oversight through a team approach beyond the bedside by proactively educating patient and family prior to discharge.