Date of Degree
Fall 2025
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Corinne Cochran
Abstract
Problem: Hospital-acquired pressure injuries (HAPIs) are preventable yet remain a significant source of patient harm, especially in high-acuity settings like the Neurocritical Care (NCC) unit. HAPIs increase morbidity, length of stay, and healthcare costs. Despite having a prevention bundle, the NCC unit exceeded national benchmarks due to inconsistent adherence, delayed consultations, and variable documentation. Addressing this issue supports the organization's goals for safety and quality, aligning with CMS and Joint Commission standards.
Aim of the Project: This 12-week quality improvement project aimed to reduce HAPI incidence in the NCC unit by implementing the AHRQ Preventing Pressure Ulcers Data Tool. The checklist reinforced existing bundle elements, streamlined workflows, and improved bedside accountability.
Review of the Evidence: Literature supports checklist-driven, multidisciplinary approaches to pressure injury prevention. Studies have highlighted that the use of standardized tools, frequent repositioning, and real-time auditing can improve consistency, communication, and outcomes in critical care.
Project Design: Using QI methodology, PDSA cycles, and the OhioHealth Change Management Model (OHCM), the project achieved a 100% reduction in HAPIs in July 2025. Overall rates decreased from 3.23 in fiscal year 2025 to 2.56 as of the fiscal year-to-date, representing a 21% reduction. Checklist use peaked at 70% in Week 1, dipped to 3% in Week 5, and rebounded to 65% by Week 8 after targeted interventions. Completion reached 100% in six of eight weeks. Staff reported no added burden, and early consultation surges were resolved through documentation clarifications.
Intervention: The AHRQ tool was deployed as a structured checklist to reinforce adherence to the bundle. Training, visual cues, and leadership rounding supported implementation. PDSA cycles addressed workflow and documentation barriers.
Significant Findings/Outcomes: The project achieved zero HAPIs in July, resulting in a 21% overall reduction, and estimated cost avoidance of $41,800 to $303,400. Staff engagement and checklist compliance improved without increasing workload.
Implications for Nursing:
This initiative demonstrates nursing’s pivotal role in quality improvement. Sustaining success requires EHR integration, policy reinforcement, leadership support, and ongoing monitoring to scale across high-risk units.
Recommended Citation
Appiah-Caslin, Elizabeth, "Reducing Hospital-Acquired Pressure Injuries in Critical Care Using a Preventing Pressure Ulcers Data Tool" (2025). Doctor of Nursing Practice (DNP) Scholarly Project. 50.
https://fuse.franklin.edu/dnp-project/50
Rights
CC BY-NC-ND 4.0
