Elimination of the Use Of Adult Briefs and Pull-Ups to Reduce Hospital Acquired Pressure Injuries

Topic/Title: Elimination of the Use of Adult Briefs and Pull-Ups to Reduce Hospital Acquired Pressure Injuries (HAPIs).

Author: Geangina Day, BSN, RN, CWOCN

Purpose: Research shows incontinence pads reduce HAPIs in acute care settings, however change is difficult due to staff and patient resistance.

Objective: Statistically significant reduction of pressure injuries achieved through elimination of adult brief usage. Quality Improvement (QI) project showed dramatic reduction in HAPIs with the disconnecting of adult briefs and implementation of incontinence pads in acute care setting in 2015.

Background: The Certified Wound, Ostomy Nurse (CWON) noted an increase in the occurrence of HAPIs and brought this to the attention of leadership and Shared Governance. Clinical problem: In February of 2015, on 29 bed medical-surgical unit the Pressure Injury Prevalence Survey revealed 12 patients with HAPIs.  A trial was established by initiating evidence-based pressure injury prevention strategies, including:

1. Developing awareness through Shared Governance and unit based QI Committee
2. Implementing incontinence pads for at-risk patients
3. Establishing a hospital-wide pressure injury prevention team
4. Eliminating pull-ups, briefs and non-absorbent pads 
5. Reducing layers of linen
6. Completing mandatory clinician in-services
7. Sharing results with hospital-wide QI teams via Shared Governance

Outcome: In April 2016 pressure injuries on this unit diminished from 12 HAPIs to one HAPI. A year later on February of 2016, zero HAPIs were present.

Conclusion: The use of incontinence pads was implemented as a part of a hospital-wide HAPIs prevention plan through Shared Governance, united-based QI and effort of pressure injury prevention skin team. The impact of these results changed nursing practice to manage incontinence patients and prevention of HAPIs. The hospital HAPIs rate was 7.9 percent in February 2015, (above acute care national benchmark of 2.5). In January 2016 the rate had declined to 2.4.