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
Lydia Forsythe, PhD
Abstract
Problem: Hospital-acquired pressure injuries (HAPIs) are a preventable, yet persistent issue in healthcare, particularly in the pulmonary and infectious disease unit of a Northeastern U.S. hospital. HAPIs prolong hospital stays, increase healthcare costs, and pose potential legal risks. Despite implementing evidence-based protocols, including the leaf patient monitoring system, the hospital reported six avoidable HAPIs cases in the early fiscal year 2025.
Aim: The quality improvement (QI) project aimed to reduce HAPIs incidents by 10% within 12 weeks by introducing turn teams and verbal reminders to enhance existing protocols.
Evidence Review: Regular turning and repositioning are essential to HAPIs prevention. Additionally, team-based strategies, such as team-building exercises and verbal cues, could improve compliance. Barriers included staffing limitations, patient refusal, and inconsistent adherence to protocol.
Project Design: The Plan-Do-Study-Act (PDSA) framework, the Ohio Change Management Model (OHCM), and the Agency for Healthcare Research and Quality (AHRQ) HAPI toolkit guided the QI project implementation.
Intervention: Patients with Braden scores ≤18 were identified daily. “Turn team” signs were placed on their doors, and the unit secretaries sent out verbal reminders every two hours to direct care staff communication devices.
Outcomes: The project achieved 93% compliance in turning and repositioning, 86.9% in skin assessment documentation, and had zero new HAPIs cases during implementation. The project demonstrated that evidence-based team-driven interventions can effectively reduce HAPIs and improve patient outcomes.
Nursing Implications: The QI initiative highlighted the importance of evidence-based, team-focused strategies in enhancing patient safety particularly in high-acuity settings, by promoting teamwork, accountability, and sustainable quality care.
Recommended Citation
Blaboe, Joyce O., "Preventing Hospital-Acquired Pressure Injuries Using Turn Teams and Verbal Reminders" (2025). Doctor of Nursing Practice (DNP) Scholarly Project. 32.
https://fuse.franklin.edu/dnp-project/32
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