Reduction of Hospital-Acquired Pressure Injuries Using a Multidisciplinary Team Approach

A Descriptive Study

Megan W. Miller, MSN, APRN, AGACNP-BC, CWON; Rebecca T. Emeny, PhD, MPH; Gary L. Freed, MD

Disclosures

Wounds. 2019;31(4):108-113. 

In This Article

Abstract and Introduction

Abstract

Introduction: Hospital-acquired pressure injuries (HAPIs) increase patient mortality and length of stay (LOS). Twenty-eight full-thickness HAPIs occurred in fiscal year 2015 (FY15), and that trend continued into FY16 with 14 injuries on multiple units throughout a tertiary acute care center with 400 beds. To address this trend, a multidisciplinary Pressure Injury Prevention (PIP) team was created.

Objective: This report is a description of ongoing, hospital-wide efforts to understand the common factors of HAPI causality and to establish corrective action plans institutionally to prevent similar events in the future.

Methods: The team goals were to document the occurrence of HAPIs across all hospital units, reduce preventable full-thickness PIs to zero, and recommend institution-wide changes as those opportunities were recognized.

Results: Since the committee's inception in July 2015, an 89% reduction of full-thickness HAPIs, with only 2 full-thickness HAPIs in FY17 and 3 in FY18, has been seen. This effort has been hospital wide with involvement of all inpatient units and perioperative areas (including the operating rooms). Opportunities remain for improvement around the prevention of deep tissue and partial-thickness HAPIs.

Conclusions: The data demonstrate that the formation of a multidisciplinary PIP team of engaged clinicians can reduce the number of preventable full-thickness HAPIs.

Introduction

Pressure injuries (PIs) are costly to patients, health care institutions, and health care consumers. These are considered never events – medical errors that should never occur – and preventable harm to patients by the Centers for Medicare & Medicaid Services (CMS). A 2016 analysis of Medicare patients estimated that the cost of severe PIs to beneficiaries was $3069 per case.[1] Data further demonstrate higher readmission rates and increased in-hospital mortality for patients who develop hospital-acquired PIs (HAPIs).[2] Review of the literature has shown an increased length of stay from 3 to 7 days for patients with any type of HAPI.[3] The true cost and magnitude of HAPI care and prevention is difficult to quantify. Codes for the International Classification of Diseases and clinical documentation are often inaccurate, as HAPIs are often not a primary hospital problem.[4] Significant variability exists in reported incidence and prevalence data due to variability in data collection and injury recognition.[5] Management of these injuries varies greatly by stage of injury and involves indirect costs, which are challenging to estimate. This usually includes an increased level of nursing care and follow-up management after discharge. Full-thickness HAPIs (stage 3, stage 4, and unstageable) may require multiple readmissions and place the patient at risk for infection and possible surgical intervention.

Several authors suggest a decrease in prevalence and incidence of HAPIs through the development of a multidisciplinary team.[6–9] With an average rate of 2 full-thickness HAPIs per month (28 total in fiscal year 2015 [FY15]) and with 186 HAPIs (all stages) in FY15, the authors worked with a multidisciplinary team to systematically address the HAPI rate.

This descriptive study was conducted to review the impact of a multidisciplinary pressure injury prevention (PIP) team designed to provide a diverse perspective of patient care and to operate as a vehicle for institution-wide implementation of best practice and data dissemination for HAPI reduction.

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