Clinical Problem: Hospital-acquired pressure injuries (HAPIs), while considered to be preventable in most cases, continue to affect many patients in acute care facilities. Hospital-acquired pressure injuries are responsible for significant patient harm in the form of pain, increased susceptibility to infection and delayed recovery. Any HAPI puts patients at risk. The rates of HAPI at one hospital were identified as putting patients at risk.
Objective: To decrease and sustain the HAPI incidences below the NDNQI benchmark average 1.28%.
Interventions/Actions: At Hospital A, chart reviews, which revealed clinical nurses’ gaps in knowledge of basic pressure wound identification, care, and prevention, resulted in education on pressure ulcer/injury care and prevention to the clinical nurses. As a result of this educational professional development activity, the clinical nurses became more engaged in the pressure ulcer/injury prevention initiative. In addition targeted wound rounds were implemented including the Wound ARNP Specialist, clinical nurses, and unit leadership. Each clinical nurse who volunteered to be a “rounder” participated in a professional development training by the Wound ARNP Specialist. This process looks at the Braden Scale score of every patient in house on that day. Our protocol of a Braden Score of 18 or less indicates that a prophylactic approach is required for those patients without skin breakdown and those with skin breakdown should be treated aggressively. Each patient is rounded on and the policy and protocols are assessed for proper implementation. The Wound ARNP Specialist at Hospital A shared the results of the team approach to HAPI reduction through education, engagement and teamwork to hospital B.
Outcomes: Data was summarized, by using a diagram to mien at pressure injury incident on a monthly basis. Hospital A launched “Wound Wednesday Rounds” in October 2015 to encourage engagement and team work. These interventions resulted in Hospital A maintaining the HAPI incident rate below NDNQI national average benchmark 1.28% up to February 2016. Hospital B, with the implementation of educational interventions, resulted in zero HAPI incidents. In December 2016, Hospital B launched “Wound Wednesday Rounds” to improve compliance and improve outcomes through engagement and team work. Hospital B was able to sustain the HAPI incident rate below NDNQI national average benchmark of 1.28% as of March 2017.
Conclusions: The results from each case study showed that education and staff engagement and teamwork are important for pressure injury prevention in which a prophylactic approach is required for those patients with and without skin breakdown. Added interventions, such as weekly rounding, facilitated the rounding team’s early identification of at risk patients. The weekly rounds allowed any deficiencies in the prophylactic approach to be corrected in real time with the consistent implementation of evidence based treatment in accordance with the institution’s policy and procedure.
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Marballie, Melissa and Johnson, Carol, "The Impact of Using Education, Engagement and Nursing Teamwork to Reduce Hospital Acquired Pressure Injury" (2018). All Publications. 2825.
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