WOC RN led committee to facilitate pressure injury prevention

Purpose:  To decrease hospital-acquired pressure injury rates.

Clinical Problem:  Hospital-acquired pressure injuries commonly occur in the acute care. The institution is perceived as providing poor care and litigation often occurs. This 525-bed acute care hospital lacked effective training, policies, or products for prevention of pressure injuries. The institution did not have clear documentation of preventative measures.

In 2015, the HAPI rate ranged from 4.32% to 4.61%. There were several hospital visits from regulatory agencies and many family complaints. Preventative methods were sporadic and bedside staff was unable to identify and implement evidence-based prevention. In addition, MASD was often mistaken for pressure injuries.

Methods:  The WOC RN discussed evidence-based practice with Nursing Administration. We immediately identified the knowledge deficit, the lack of accountability, gaps in communication, and the limitations of product availability.

The point-prevalence studies were revamped and taken over by the WOC RN. This included having a dedicated team, pre- and post- teaching sessions, bedside teaching, mandatory completion of the NDNQI modules, and confirmation by the WOC RN of patient’s identified to have HAPI’s.

10 months later, it was decided to form a committee that would be chaired by the WOC RN. This committee met monthly on point-prevalence days. Topics include prevention, commonly misidentified wounds, demonstration of offloading and pressure redistribution, and incontinence management.

Outcomes: The committee included RN’s and Nursing Assistants from all medical-surgical units, ED, pediatrics and ICU’s. The committee would go on to create a skin bundle, initiate unit-based skin champion program, create an evidence-based skin/wound algorithm, and plan a fun and educational Skills Fair event.

With leadership from the WOC RN, the committee members would bring education back to their units and ultimately change bedside practice. This resulted in the HAPI rates decreasing from 2.54% to 0.54% in 2016 and so far to 0.25% in 2017.