Nurse-Led System-wide Unit-based Hospital Acquired Pressure Injury (HAPI) Reduction Project

Background

In Hamad Medical Corporation (HMC) facilities, approximately 45 incidents of Hospital acquired pressure injuries (HAPI) were reported monthly between 2018 and 2021. Medical devices contribute to approximately 50% of these total HAPI. HAPI is a significant patient safety issue in hospitalized patients and can lead to increased healthcare costs and a decreased quality of life for patients . A retrospective data analysis identified issues such as knowledge gaps, lack of continuity of care, and nursing practice variations. Nursing and Midwifery implemented an integrated project to reduce HAPI through evidence-based best practices to reduce the HAPI incidence rates by 50% in all facilities by the end of Q3 2022.

Methods

A quality improvement project was conducted using the Agency for Healthcare Research and Quality (AHRQ) Comprehensive Unit-based Safety Program (CUSP) model to implement the HAPI Project. 3 Unit-based HAPI champions were identified, drove the implementation of this project across HMC. It entailed revising the HAPI prevention and management guideline to integrate evidence-based practices and focused on strengthening the clinical competency of HAPI champions and frontline nurses. Spot audits were conducted to assure the compliance to the Surface, Skin inspection, Keep moving, Incontinence and Nutrition bundle (SSKIN bundle) at unit level.

Results

The rate of HAPI incidence was significantly reduced by 65.58% post?implementation, from 0.9/1,000 patient-days [Q3 2020 – Q4 2021] to 0.31/1,000 per patient-days [Q1 2022 – Q2 2023] (Figure 1). The Medical-Device Related Pressure Injuries (MDRPI) was reduced by 67.87%, from 0.46/1,000 patient-days [Q3 2020 – Q4 2021] to 0.15/1,000 patient-days [Q1 2022 – Q2 2023] (Figure2). The efforts were successful to sustain the outcomes of the project by addressing challenges and sharing the best practices across HMC.

Conclusion

The HAPI reduction project successfully reduced hospital-acquired pressure injuries and improved patient outcomes through consistent frontline staff engagement and nursing leadership support.