Hospital-acquired pressure injuries are a significant issue, costing $11 billion annually in the US. A fishbone diagram was used to identify multiple factors that influence pressure injury development, including patient characteristics, materials, staff, processes, environment, and methods. Evidence shows that involving patients in their own care through education on positioning, mobility, and prevention can help reduce injuries. Evaluating prevention strategies and pressure injury rates through staff meetings and assessing staging can help hospitals improve processes and decrease injuries over time.

1. Hospital Acquired Pressure
Injury Prevention
Jonathan Juca, Shelby Mandel, Samantha Rislove, Megan Zhang, Gabi Zweig

2. Why did we choose this topic?
Hospital Acquired Pressure Injuries (HAPIs) are a significant patient safety and quality care issue.
-2.5 million patients acquire a HAPI each year
-60,000 cases result in death
-$11 billion spent annually treating HAPI in the US
-HAPI are preventable
Unit specific: Majority of patients on 5500 are older than 75 years and confined to bed. These factors
contribute to the development of a HAPI.

3. What is a Pressure Injury?

4. Fishbone Diagram

5. Description of Fishbone
We looked at the primary factor that can influence HAPI:
● Patient
Then we looked at other factors that we can change and prevent HAPI:
● Materials
● Interprofessional Staff
● Process
● Environment
● Methods

6. Summary of Literature
Pressure Injury Prevention Team : The PIP team believes the decrease in full-thickness
injuries is related to multiple factors, including earlier recognition of injuries before they evolve to
full thickness and a greater awareness/shared responsibility of preventing injury before it
occurs”
Patient Involvement in Care: Evidence show that when the patient is involved in their care, there
are positive outcomes, such as: Improved healthcare satisfaction, Reduced adverse events,
shorter length of hospital stay, and Increased patient safety. Getting the patient involved in PIP
care can be very complex. There are mixed messages that nurses are sending to their patients
regarding PIP involvement, since some nursing think it is challenging to involve patients. There
needs to be a collaborative approach to have the patients involved in their care as equals.

7. Summary of Literature (cont.)
Braden Scale Application: This study suggests that while it is best to provide basic preventive pressure
injury care to all hospitalised patients, through Braden Scale applications, hospitals still need to
invest in technologies and people that enhance preventive efforts.
Positioning and Mobility: Hospitalized patients spend a significant amount of time in bed despite
ability to get out of bed and walk around - Nurses to educate these patients. Adopting a targeted and
individual sized approach to repositioning is recommended to best meet patient needs.
Materials: A robust sample of acute care hospitals experienced significant reductions in counts of
hospital-acquired stages 3, 4 and unstageable pressure injuries following the adoption of
prophylactic 5-layer foam sacral dressings. Significant pressure injury rate reductions in US acute
care hospitals between 2010 and 2015 were associated with the adoption of prophylactic 5-layer
foam sacral dressings within a prevention protocol.

8. Education Deliverable

9. Barriers and Facilitators to Implement
Change
Barriers:
● Limited amount of staff
● Patient to Staff ratio
● Lack of Knowledge on behalf of staff
● Physical skill
● Patients’ willingness and knowledge
Facilitators:
● Fewer materials will need to be used in the
long run
● HAPI meetings, woundrounds, huddles
● Beliefs about capabilities on behalf of the
patient
● Reputation of hospital and unit
● Effective communication

10. Evaluation of Changes
Pressure Injury Prevention Team:
● Schedule meetings/huddles with PIP team to discuss effectiveness of their meeting with patients.
● Explore with patient whether meeting with PIP team was helpful and useful to them and their
knowledge of acquiring PIs.
Patient Involvement in Care:
● Ask patient how involved they have been in their own care/in what capacity?
● Have they been cognitive of how long they have been in a certain position?
● Did they reposition themselves for purposes of a shift in pressure without the nurse telling them
to?

11. Evaluation of Changes
Braden Scale Application:
● Assess if risk stratification has worked in regards to the Braden scale.
Positioning and Mobility:
● How often did patients get out of bed and walk around?
Materials:
● Ask nurse if preventive materials were successful in stopping the creation of a PI

12. Evaluation of Changes
● Units could have a monthly staff meeting evaluating rates of pressure ulcers for that
month. Doing this will be able to show the trends of pressure injuries and whether they
have increased or decreased on the unit, and what the staff could continue or improve
on.
● Evaluation of degree and staging of pressure injuries
● Evaluating the degree to which nurses are educated about pressure injuries. The
greater the nurse’s knowledge and competency about pressure injuries, the chances
of acquiring pressure injuries in patients decrease.

13. References
Latimer, S., Chaboyer, W., & Gillespie, B. (2014). Patient participation in pressure injury prevention: giving patients a voice. Scandinavian
Journal of Caring Sciences, 28(4), 648–656. doi: 10.1111/scs.12088
Latimer, S., Chaboyer, W., & Gillespie, B. M. (2015, July 14). The repositioning of hospitalized patients with reduced mobility: a prospective jkljkjkjstudy.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047314/
Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2018). Barriers and facilitators to preventing pressure ulcers in nursing home residents: A
jkjkjjkkqualitative analysis informed by the Theoretical Domains Framework. International Journal of Nursing Studies, 82, 79–89. doi:
jkjkljkj10.1016/j.ijnurstu.2017.12.015
Miller, M. W., Emeny, R. T., & Freed, G. L. (2019, April). Reduction of Hospital-acquired Pressure Injuries Using a Multidisciplinary Team
Approach: A Descriptive Study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586476/
Padula W. V. (2017). Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in
Acute Care Hospitals: An Observational Cohort Study. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy
and Continence Nurses Society, 44(5), 413–419. https://doi.org/10.1097/WON.0000000000000358
Padula, W. V., Pronovost, P. J., Makic, M. B. F., Wald, H. L., Moran, D., Mishra, M. K., & Meltzer, D. O. (2019, February). Value of hospital
resources for effective pressure injury prevention: a cost-effectiveness analysis. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365919/