Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Lydia Forsythe

Second Advisor

Dr. Mary Colvin

Third Advisor

Anthony Schreiter

Abstract

Problem: Hospital-acquired pressure injuries (HAPIs) contribute to increased morbidity, extended hospitals stay, and significant healthcare costs. At the project site in northwest, Indiana, HAPI rates averaged 6.29%, which significantly higher than the national benchmark of 2.24%. Inconsistencies in documentation, a lack of standardized preventive practices, and variable staff engagement contributed to these increased rates. Despite the use of the Braden Scale, staff inconsistently implemented preventive interventions.

Aim of the Project: The aim of the project is to reduce HAPI incidence by 30% over 10 weeks by implementing the surface, skin inspection, keep moving, incontinence/moisture management, and nutrition (SSKIN) bundle and improve staff compliance and documentation.

Review of the Evidence: Multiple studies have shown the SSKIN bundle reduces HAPI prevalence and improve consistency in care. Research by Gupta et al. (2020), Kennedy (2023), and Singh et al. (2023) demonstrated statistically significant reductions in HAPIs and highlighted the need for ongoing staff education and leadership engagement.

Project Design: This quality improvement initiative used the plan-do-study-act (PDSA) model and the OhioHealth Change Management Model (OHCM) to guide implementation. These frameworks supported testing, continuous adaptation, and staff engagement.

Intervention: The intervention involved education, weekly chart audits, staff rounding, and three PDSA cycles focused on engagement of float and night shift nurses, improved nutrition workflows, and early detection of skin damage. The project targeted adult medical-surgical patients over a 10-week implementation period.

Significant Findings/Outcomes: HAPI rates declines to 0.00% by the final month of implementation, achieving the 30% reduction goal. Compliance with the SSKIN bundle reached 60%, with progress in appropriate surface usage and timely consults. No new stage III or IV HAPIs occurred and deep tissue injuries (DTIs) were proactively addressed in PDSA cycle 3.

Implications for Nursing: Standardizing preventive practices improves patient safety and reduces financial burden. Engagement across all staff levels and real-time reinforcement is vital for sustainability.

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