Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Document Type

Poster

Publication Date

10-5-2025

Abstract

BACKGROUND: A pressure injury (PI) that occurs during a patient’s admission is called a hospital-acquired pressure injury (HAPI). HAPIs result in loss of revenue, increased length of stay, and greater mortality risk. PIs occur most frequently in critical care, at a rate much higher than in any other setting. The Braden scale is commonly used to assess PI risk for all patients, but does not include risk factors associated with medically complex care.

LOCAL PROBLEM: The setting for this quality improvement project was a 30-bed Long-Term Acute Care Unit (LTAC), a critical care hospital where medically complex patients receive intense treatment for extended periods. In 2023, there was an increase in heel-specific HAPIs at the project site. The purpose of this quality improvement project was to implement an evidence-based risk assessment on admission and allocate a Repose flex cushion to high-risk patients. The project's aim was to reduce the occurrence of heel-specific HAPIs by 100%.

METHODS: The Evidence-Based Practice Improvement (EBPI) model was used as a framework to guide this project. A review of current evidence reflected the inferiority of the Braden scale alone when assessing PI risk for those who are critically ill. In previous studies, preventative cushions have proven effective in reducing HAPIs in similar patient populations. Heel-specific HAPIs were measured and compared pre- and post-implementation. Staff compliance with risk assessment and cushion compliance were also measured.

INTERVENTIONS: All patients were screened on admission for PI risk based on Braden score and ICU-specific risk factors. Patients who were positively screened received a preventative cushion on the same day.

RESULTS: A total of 109 patients were admitted to the LTAC unit. Based on ICU-specific risk factors, 58 patients (52.7%) qualified for a Repose cushion on admission and 54 patients (93%) received a cushion on the same day. No heel-specific HAPIs were identified during the five months of project implementation.

CONCLUSION: The use of a standardized risk assessment led to improved identification of patients at risk for developing a PI. Early identification combined with preventative cushions significantly reduced the occurrence of heel-specific HAPIs in this patient population.

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