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.
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.
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/
Notas do Editor
Speaker: sam
Speaker: sam
Speaker: sam
Definition: localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful.
Speaker: megan
Speaker: megan
The patient is the primary focus and the most important factor. As nurses we must advocate for the patient’s health and safety. The development of pressure ulcers is a concern for patient safety and quality, putting the patient at risk for infection. Our group's first process improvement step is to ensure that at risk patients are provided detailed education, emphasize the importance to report skin redness, and encourage ROM exercises. Following patient communication, the next step is to provide a safe environment. One way in doing that is by arranging position change schedules and moisture checks to prevent skin breakdown.
The next part of the diagram takes a step back and examines factors that can be implemented by the facility. Beginning with the med surg staff, our group expressed the need for med surg nurses to apply the Braden scale to all patients on the unit. Upon discussion with the staff members, they emphasized the need for better staffing to improve call light response time and a faster response to incontient episodes. We also asked for suggested hospital materials to prevent HAPI. The staff mentioned the need to acquire more barrier creams, wedges for positioning, special mattresses, and heel lifts. Some of these materials help to lift and protect the patient’s skin from pressure caused by immobility. Lastly, our group investigated the hospital/unit process coordinated specifically for HAPI prevention. We suggested weekly HAPI meetings, discussing specific patients at risk for developing pressure ulcers during morning huddles, and completing wound rounds at least one time per shift.
speaker=gabi
PIP=we believe in a team that is fully dedicated to focusing on patients’ pressure injuries, even before they happen. This team should visit every newly admitted patient to assess their situation and see how they can best be prevented from pressure injuries.
Patient Involvement=it is important to give them a proactive role so they can prevent it themselves. so these are the main goals that we look for
speaker=gabi
braden= Stratisfying high risk patients with lower Braden Scores would improve health outcomes at reduced costs by focusing prevention efforts on patients of highest need. This study showed that Risk stratifying patients and providing pressure-injury prevention only to patients with Braden scores <15 was less costly and more effective than standard care. But when it comes to follow-up care, that should be given to ALL patients who have pressure injuries, not only high-risk patients .
Positioning and mobility= so this basically means (as i said before) taking these patients as case-by-case scenarios and assessing their situation and seeing what exactly they need in order to prevent pressure injuries. Specifically in terms of repositioning due to their tendency to stay in bed even if they do not need to. unfortunately there is no position that puts zero pressure on any part of the body. So whenever you are in bed, part of your body will be prone to pressure, but that is why it is important to keep moving the parts.
Speaker: shelby
We asked one of the nurses on the unit as we listened in to one of the huddles, we head that… which is why we thought this would be an effective topic.
Easily accessible to the busy staff
Speaker: shelby
Fewer materials- cuts time down the road and also saves the hospital money
Patient involvement in their own care
Speaker: jonathan
This relates to each specific point about our research on the previous slides (summary of literature etc.)
