Implementing Hospital-Acquired Pressure Injury (HAPI) Prevention Program

Practice Problem: Hospital-Acquired Pressure Injury (HAPI) is a serious problem in patient care and has deleterious implications for the patient and the healthcare system. A 530-bed acute care hospital in the Rio Grande Valley identified a similar challenge and implemented a HAPI preventive program. PICOT: This evidence-based practice (EBP) project was guided by the following PICOT question: In the Intensive Care Unit/Medical Intensive Care Unit (ICU/MICU) patients aged 18 and older, does a pressure preventive bundle, compared to routine pressure injury care, reduce the incidence of pressure injury, within 21 days? Evidence: The reviewed literature supported evidence of effective use of a pressure injury preventive bundle in reducing the incidence of pressure injuries in an acute care setting. Seven articles met the inclusion criteria and were used for this literature review. Intervention: The evidence-based pressure injury preventive bundle are interventions that included consistent skin risk assessment and the application of a group of clinical practice guidelines composing of moisture management, optimizing nutrition and hydration and minimizing pressure, shear, and friction that were proven to prevent the occurrence of pressure injuries. Outcome: Post-implementation findings showed that there was no reduction in the incidence of HAPI but significant decrease in the severity of the pressure injury from Stage two to Stage one. Conclusion: The staff education, training, and implementation of an evidence-based bundle intervention to prevent the incidence of HAPI proved a positive outcome on reducing the pressure injury severity from Stage Two pressure injuries to Stage One pressure injuries. HOSPITAL-ACQUIRED PRESSURE INJURY PREVENTION PROGRAM 4 Implementing Hospital-Acquired Pressure Injury (HAPI) Prevention Program Pressure injuries (PIs) remain a major concern locally, nationally, and globally. In April 2016, the National Pressure Ulcer Advisory Panel (NPUAP) replaced the term pressure ulcer with pressure injury in the NPUAP Injury Staging System to reflect injuries in both intact and ulcerated skin (Edsberg et al., 2016). Pressure injuries are injuries to the skin and underlying tissues caused by constant pressure (Reilly, Karakousis, Schrag, & Stawicki, 2007). Any prolonged and unrelieved pressure causes occlusion of blood flow, ischemia, and ultimately cell death. (Reilly et al., 2007). HAPI is a serious problem in patient care and has deleterious implications for the patient and the healthcare system. HAPIs leads to enormous patient suffering as well as an excessively high healthcare expense. The Centers for Medicare and Medicaid Services (CMS) identifies PI as Never Events; an event that a patient should not incur while in the hospital and CMS no longer provides reimbursement for care related to these events (Armour-Burton, Fields, Outlaw, & Deleon, 2013). Several evidence-based clinical practices have been implemented and adopted by healthcare organizations to prevent or reduce the incidence of pressure injury. The purpose of this EBP project is to decrease the incidence of HAPI by 15% over the three weeks of the introduction of the HAPI prevention bundle to the Intensive Care Unit/Medical Intensive Care Unit (ICU/MICU). Significance of the Practice Problem Pressure Injuries (PIs) are injuries to the skin or underlying tissues over bony prominences because of pressure, shear, and friction (Zuo & Meng, 2015). PI remains a challenge worldwide. PIs harms patients by a longer recovery period, causing pain, potential infections, and increase in healthcare cost to both the patient and the hospital/healthcare setting HOSPITAL-ACQUIRED PRESSURE INJURY PREVENTION PROGRAM 5 (Grealy & Chaboyer, 2012). The need to decrease the incidence of HAPI in the ICU/MICU was vital. Data from the wound care system reported 127 HAPIs for 2018, which was an increase of 40 HAPIs from 2017. The financial impact of these Never Events is significant, with a cost ranging from $2,000$40,000 per PI, depending on the stage of the PI (NPUAP, 2014). The cost alone, without the cost of human suffering, demonstrates the importance of preventing PIs and the importance of cost-effective, preventative practices (Ostadabbas et al., 2012). The scope of the problem is significant on multiple levels. Estimates indicated that one to three million people in the United States develop PIs each year (Kruger, Pires, Ngann, Sterling, & Rubayi, 2013). The Joint Commission on Patient Safety estimates that more than 2.5 million patients in acute care facilities suffer from PIs and that 60,000 dies from PI-related complications each year (Kruger et al., 2013). The CMS penalty, potentially withholding reimbursement for Hospital Acquired Conditions (HAC), negatively affects the organization’s finances.