Implementation of a Hospital-Acquired Pressure Injury Prevention Admission Bundle

Abstract

Problem: Within a community hospital located in central Maryland, an adult intensive care unit (ICU) had an increased Hospital Acquired Pressure Injury (HAPI) incidence average rate of 2.2% per month during the months of July and August 2020. A potential cause identified was an inadequate nursing skin assessment on patient admission. Purpose: The purpose of this quality improvement project was to implement a HAPI prevention admission bundle that has been shown to reduce the number of HAPIs in an adult population. The bundle included four care components: completion of the Braden Scale score, performance of a two-nurse skin assessment, use of a pressure reducing surface, and application of a prophylactic sacral foam dressing. Methods: The adult ICU consisted of 30-beds and treated approximately 200 patients per month. The bundle was initiated by nursing staff at patient admission and all components were expected to be completed within 24-hours. Nursing education was administered and completed by the staff who worked in this unit. The use of the bundle was measured twice per week by chart audits. The HAPI rate was measured monthly by the hospital’s incident management system (RL6). Bundle documentation compliance and monthly HAPI rate were analyzed using run-chart analysis. Results: 86% of staff nurses were educated about the bundle. The documentation compliance of the bundle during the last four weeks of data collection was a 79% average. The post-implementation HAPI monthly incident rate average increased to 4.1%. Conclusions: The HAPI prevention admission bundle did not improve the average monthly ICU HAPI incident rate during a 14-week implementation effort. The documentation compliance of the bundle components improved over time, due to regular feedback of the chart audit results. COVID-19 precautions altered the standards of care during the implementation phase, which may have influenced the increased HAPI incidence rates during November and December. The HAPI prevention admission bundle was useful in increasing documentation compliance of four vital skin care components. A future quality improvement project should focus on adding additional evidence-based skin care components to the bundle and extending the implementation phase to ensure 100% of staff are educated to improve utilization of the bundle elements.