Relevance/Significance: Hospital Acquired Pressure Injuries (HAPIs) are costly and considered to be a preventable hospital-acquired condition within the acute care setting (Centers for Medicare & Medicaid Services [CMS], 2018). In 2017, the HAPI incidence rate data within our 500+ licensed bed tertiary hospital revealed that more than 28% of HAPIs developed in our 32-bed intermediate care unit. Skin champions took on the challenge of educating their peers on the new knowledge, evidence-based practice, and innovations being implemented to reduce pressure injury rates within the unit. This transformation in clinical nurse leadership, autonomy, and accountability for nursing practice was needed in order to achieve our goal of zero HAPIs.
Strategy/Implementation: The Pressure Injury Prevention Committee (PIPC) is a hospital wide, interdisciplinary team focused on HAPI prevention. Skin champions from our intermediate care unit participating in this council were inspired to educate their peers on the evidence-based pressure injury prevention protocol (National Pressure Ulcer Advisory Panel [NPUAP], 2013; NPUAP, European Pressure Ulcer Advisory Panel [EPUAP], Pan Pacific Pressure Injury Alliance [PPPIA], 2014; Wound, Ostomy, and Continence Nurses Society, 2017). This consisted of measures such as:
- 2 RN head-to-toe skin checks upon transfer/admission
- Daily 2 RN skin check on patients with a Braden score of 15 or below
- Proper use of devices, documentation, and consultation (NPUAP, 2013).
Skin champions were coached by WOCNs and Clinical Nurse Specialists on how to best lead the unit wide implementation beginning in May 2017. The skin champions started by using peer-to-peer education to introduce and expand the initiative. Skin champions then expanded their responsibilities to include a weekly unit head-to-toe skin check on patients with a Braden score of 15 or below and provided peer-to-peer feedback to ensure sustainability of the evidence-based practices. Peer-to-peer education and feedback continues for any new and current staff members for initiative sustainability.
Evaluation/Outcomes: The intermediate care unit found a significant reduction in pressure injuries within the first month of implementation. According to CALNOC the intermediate care unit’s percent of patients with pressure injuries category II+ or above in the first quarter of 2017 was 16%. In the second quarter of 2017, when the initiative was started, the percentage decreased to 3.23%. By the third quarter, the national benchmark was passed and the percentage of patients acquiring pressure injuries dropped to 0%. Over the next 2 out of the 4 quarters the percentage of patients acquiring pressure injuries category II+ or above within the intermediate care unit was 0%, with the other 2 quarters having a rate of 3.33% and 3.23%.
Implications for Practice: Using direct staff nursing involvement, the HAPI reduction initiative was able to achieve a considerable decrease and sustainability in the percent of patients having acquired a pressure injury. To maintain sustainability, the weekly skin rounds continue, and skin champion numbers continue to increase. The initiative has gone facility-wide and has shown a decrease in the number of HAPIs within the organization. According to Medicare $43,180 is added to the cost of hospital admission for each patient that acquires a pressure injury (Agency for Healthcare Research and Quality [AHRQ], 2014). Based on cost, an estimated $315,214 has been saved for our organization over the last 9 months following initiative implementation. Staff skin champions being the main educational force and having ownership of peer-to-peer feedback has shown a positive outcome in preventing and sustaining a low percentage of hospital acquired pressure injuries.