Focusing on Braden Subscale Assessment and Interventions for Hospital Acquired Pressure Injury Prevention in Medical Surgical Units at a Safety Net Hospital: A Quality Improvement Project

In FY17/18 HAPI's in Medical-Surgical units had reached the lowest reported number in the past 3 years, with a reduction to 1 reportable HAPI in FY17/18 compared to 20 in FY16/17, which was a direct result of the Braden PDSA(3). In FY14/15 executive leadership at ZSFG(1) selected HAPIs as a hospital priority metric and we began utilizing A3(2) problem solving tools, which led to the Braden PDSA. We collected data on HAPI location and stage, unit, device-related, diagnosis, and Total Braden Score. We retrospectively looked at the Braden score on admission of patients who acquired a reportable HAPI in FY16/17. Analyses revealed that 35% of patients who acquired a HAPI were assessed as having a mild/no risk(≥14) on the Braden Scale, leading to our PDSA which improved the HAPI prevention infrastructure. Even though ≥14 was the threshold for being at risk, nurses were not consistently implementing interventions in order to prevent HAPI’s from developing and were copying and pasting the previous Braden shift assessment, decreasing the reliability of the Total Braden Score(4). This PDSA utilized the Braden Scale as a driver, and prompted collaboration with interdisciplinary teams. The PDSA was conducted over a 14-week period on a Medical-Surgical unit, where various resources were introduced: presenting audit data, case studies of previously reported HAPIs to CDPH(5), peer-to-peer nurse rounding, dissemination of wound lexicon, and an electronic health record revision to reflect Braden sub-component emphasis. In order to measure improvement, we defined the compliance rate as the percentage of interventions documented when the Braden sub-category was scored as ≤2. Baseline data showed that nurses documented interventions 41% of the time when the Braden Sub-category was ≤2(n=201 categories scored ≤2 in week 2). The weekly compliance rates, increased from 41%(n=201) in week 2 to 74%(n=84) in week 11, and 64%(n=63) in week 13.