Decreasing Hospital Acquired Pressure Injuries (HAPI) through SSKIN (Skin Assessment, Surface, Keep Moving, Incontinence, Nutrition) Care Bundle.

Problem Statement: Hospital-acquired pressure injuries (HAPI) result in significant harm, including avoidable patient suffering, decreased patient satisfaction, increased length of stay, increased costs, and financial penalties due to declined third party payer reimbursement. The recent financial implications for all hospital-acquired conditions have directed the healthcare focus to prevention.

Purpose: This evidence-based practice improvement project was implemented to decrease the occurrence of HAPI within three months of initiation on a Progressive Care Oncology Unit through the implementation of the SSKIN (Skin Assessment, Surface, Keep Moving, Incontinence, and Nutrition) bundle.

Description of innovations: A review of the pressure injuries data identified practice gaps leading to the development of an evidence-based pressure injury prevention protocol. Strategies for planning and implementation included the following: collaboration with the hospital wide skin team and unit leadership; staff education through daily huddles and meetings on skin and risk assessment, documentation, and prevention; monthly data analysis; and ongoing rounding with one on one staff education. A major component of prevention was the SSKIN Bundle with corresponding effective interventions. One of the interventions was the prophylactic use of Mepilex® Border sacral and heel dressings where a thorough staff education and follow up was provided by Molyncke representatives. Regular attention to HAPI continues to be a priority and was added as a metric to the unit’s Daily Management System for real time compliance tracking. Based on the audit results, weekly goals were set and met.

Outcomes: HAPI rate decreased from four the previous quarter to zero post-implementation.

Implications/significance: A significant change in the culture among the multidisciplinary team from treatment to prevention was noted. Improvement in the accuracy of RN skin assessments and interventions were also evident.

Recommendations: Communication and dissemination of the SSKIN care bundle and facilitate hospital wide adaptation.