Decreasing Hospital-Acquired Pressure Injuries by Implementing Four-Eyes Assessment

Abstract

Problem: In the last fiscal year, Unit A recorded a total of 12 hospital acquired pressure injuries (HAPIs) and has reported greater than 7 HAPIs thus far in fiscal year 2023. HAPIs lead to higher morbidity, mortality, high financial costs, and increased length of stay for patients. Purpose: This quality improvement initiative, implemented in Fall 2023, utilized Four-Eyes Assessment, an evidenced-based best practice used to identify wounds on admission. The expectation was an increase in documentation of present on admission wounds (POAs) and fewer HAPIs. Method: The Knowledge-to-Action Model (KTA) was the framework aligning with this project. Two nurses completed, documented, and cosigned a head-to-toe focused skin assessment on patients within four hours of admission to the unit. For altered skin, a wound consult was placed into EMR triggering a wound nurse follow-up. All patients ≥ 18 years admitted to Unit A from September to December 2023, except for those receiving end-of-life care or actively dying, were included in this initiative. Champions completed weekly chart audits, using the Four-Eyes Assessment data collection tool. Data was entered into REDCap system by the writer for analysis. Monthly HAPI rates were calculated and compared for clinical significance. Results: There were 531 patients admitted to unit A during the implementation period. 66% (n=349) of those patients had a Four-Eyes assessment documented as completed. 52.4% (n=183) of those patients had a wound documented as present on admission (POA). Out of those 183 POA wounds, 94.5% (n=173) had a wound consult placed. Conclusion: The implementation of the Four-Eyes Assessment resulted in improved identification of wounds that were present on admissions or transfers into Unit A. There was also improved compliance with the placement of wound consult orders. Additionally, during the monthly hospital wide pressure injury prevention survey, no hospital-acquired pressure injuries were identified for Unit A since implementation of this evidence-based initiative.