Date of Degree

Fall 2023

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type


Degree Name

Doctor of Nursing Practice

First Advisor

Debbie Conner


Problem: The purpose of the project was to address the increase in pressure injuries in a skilled nursing facility, which had risen from 6% to 10% despite the implementation of a prevention bundle. The project aimed to evaluate and enhance the effectiveness of existing interventions.

Aim of the Project: The aim was to add evidence-based interventions to the existing pressure injury prevention bundle. The desired outcome was to decrease the number of acquired pressure injuries.

Review of the Evidence: Research indicated that pressure injury prevention bundles were more successful when incorporating offloading interventions. These offloading measures, including frequent turning and repositioning of patients, utilizing air mattresses for individuals with a Braden score of 14 or below, and implementing a reminder strategy, have proven to be beneficial in reducing pressure injuries.

Project Design: The quality improvement framework guided this practice change project, with the Plan-Do-Study-Act cycle facilitating the testing of changes. Four cycles were conducted to identify and mitigate any barriers. The OhioHealth Change Management Model played a crucial role in communication and addressing potential obstacles.

Intervention: Modifications to the pressure injury prevention bundle involved changing the Braden Scale score cut-off to 14 for air mattress issuance and adding frequent turn and repositioning to nursing duties. This was enabled by making it a standing order and inserting reminders in the electronic medical record. Nursing leaders monitored implementation in weekly meetings.

Significant Findings/Outcome: The incidence rate, which represents the number of patients developing new pressure injuries after admission over a specific time, was 6.2% prior to implementation. After implementation, this rate significantly decreased to 1.74%, a 72% reduction from the baseline. This demonstrates that reviewing and modifying the pressure injury prevention bundle to incorporate evidence-based practices effectively reduced the occurrence of acquired pressure injuries.

Implications for Nursing: Implementing evidence-based interventions for preventing acquired pressure injuries is in alignment with the objectives of the Institute for Healthcare Improvement Triple Aim. This approach not only reduces the incidence of pressure injuries, enhancing patient health and satisfaction, but also curtails care costs. Moreover, it adheres to the Six Aims for Healthcare Improvement by incorporating effective and safe offloading measures to mitigate the occurrence of pressure injuries.


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