Implementation of a unit-specific quality improvement process for prevention of hospital-acquired pressure injuries

Hospital-acquired pressure injuries (HAPIs) occur in 3%-34% of patients admitted to hospitals worldwide. Early intervention of an HAPI prevention process can help prevent or reduce HAPIs. The aim of this study was to develop a hospital unit-specific quality improvement process (QIP) focused on sacral HAPI prevention. A sudden increase in sacral HAPIs within an acute care intensive care unit (ICU) during 2022 at a 308-bed acute care hospital prompted concern with current practices in patient turning and repositioning. Within a Plan-Do-Check-Act format QIP in an adult ICU-specific QIP, the following areas were addressed (1) assessment planning using staff surveys, fishbone diagram, run chart data collection and failure mode effect analysis, (2) do processes with staff education, product utilisation that included glide sheets, 30° offloading wedges and drypads, and flow revamp, (3) ongoing data review through run chart interpretation and (4) acting within the multidisciplinary team to hold the gain. Following initial implementation of the 30° offloading wedges during January 2023, the rate of sacral HAPIs decreased from 18 to 4.6 per 1000 patient days per month. During a 3-month period that included full implementation of an ICU-specific QIP and use of glide sheets, 30° offloading wedges and drypads, the total number of sacral HAPIs decreased to one. Overall, the mean rate of sacral HAPIs per 1000 patient days per month decreased from 4.49±5.31 during 2022 to 2.30±2.21 during 2023, representing an approximate decrease of 50%. The total number of sacral HAPIs decreased from 24 in 2022 to nine in 2023. The improvement has been sustained with one HAPI noted for 2024 and zero HAPIs for 2025 through April. The implementation of an ICU-specific QIP and combined use of friction-reducing glide sheets, 30° offloading wedges and full body drypads was successful at decreasing the sacral HAPIs.