Structured Quality Improvement to Reduce Hospital-acquired Pressure Injuries

An Academic Medical Center in the United States faced a high rate of hospital-acquired pressure injuries (HAPIs), prompting a quality improvement (QI) project. HAPIs have not received the same level of attention for prevention as other significant hospital complications, such as central line-associated bloodstream infections (CLABSIs) and venous thromboembolism (VTE), but contribute to morbidity, increased costs, and negatively impact patient care. They can be reduced by applying core strategies for other hospital-acquired conditions (HACs). The goal was a 50% reduction in HAPIs over 18 months by teams using structured improvement tools.

The program was developed by a Wound Oversight Committee and aimed to evaluate how risk assessment and early prevention could decrease the occurrence of HAPIs below the national mean. Patients admitted to this hospital between 2021 and 2023 were included in this quality project.

Two-person skin assessment within 4 hours of admission improved from 20% to over 80% within 18 months, leading to timely preventative measures. These interventions by teams helped reduce HAPIs from 14 to 7 per month. Standardization of collection, review, and validation of administrative data for public reporting was implemented alongside clinical improvements, with a HAPI rate decrease from 1.87 per 1000 eligible discharges in 2017 to 2019 to 0.40 in 2020 to 2022 ( P -value <0.05).

This study demonstrated that establishing a structured QI program using proven HAC reduction strategies, risk assessment and timely preventive practices significantly reduced HAPIs. The improvements observed are comparable to those seen in CLABSI and VTE rates.