Reducing Hospital Acquired Pressure Injuries among Spinal Cord Injury Patients

Abstract

Problem: The spinal cord injury (SCI) unit of a local rehabilitation hospital in Baltimore, Maryland experienced hospital acquired pressure injury (HAPI) incidence rates above the facility standard rate of 0.77. HAPI incidence rate was 1.53 in 2021. A new benchmark was established in 2022 based on the Uniform Data System reporting at 1.20%. Despite implementation of interventions to address this problem, the HAPI rate was 3.45% at the end of August 2022. Purpose: the purpose of the quality improvement was to implement a HAPI prevention admission bundle on the SCI unit to reduce HAPI rates. Methods: Nurses (RN and LPN) were educated on the HAPI prevention admission bundle and took a paper-based post-test to evaluate assimilation of the educational objectives. Implementation of the bundle began on the second week. Within four hours of admission, two nurses initiated a comprehensive skin assessment. The admitting nurse (RN) documented the skin findings in the electronic health record (EHR) visual skin tool, inserted the tool into a progress note, and requested a co-sign from the second nurse. All new admissions ages 18 years and older were included. Bundle compliance was measured weekly by chart audits in the EHR. Results: 86% of nurses (n = 13) were trained with a post-test average score of 95%. Over a period of 14 weeks, 64 patients were admitted to the unit. Overall HAPI bundle compliance rate was 90% (n = 57), and 97.4% of admissions (n = 62) had an admission skin assessment completed within 4 hours of admission. Documentation on the visual skin tool was completed for 91% of admissions (n = 59) and two-nurse co-sign completed for 90% (n = 57). Post-implementation HAPI rates dropped to 1.87%. Conclusions: The HAPI prevention admission bundle was effective in reducing HAPI rate. Formal staff education, unit champions, leadership involvement, and staff reminders were important tactics utilized for the adherence and adoption of the implementation