Date of Degree
Summer 2024
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Melanie Brewer
Second Advisor
Dr. Corinne Cochran
Abstract
Problem: Facility-acquired pressure injuries (FAPIs) pose significant risks to patient outcomes and healthcare costs ($500 to $70,000 per PI) in subacute rehabilitation (SAR) facilities. An assessment in a SAR identified a concerning pressure injury (PI) rate of 15.3%, exceeding the national benchmark of 10% for such facilities. This prompted an evidence-based quality improvement (QI) initiative.
Aim of the Project: This project aimed to reduce FAPI rates by 30% or greater among patients 65 and older using a PI prevention bundle called SSKINS (Skin, Surface, Keep moving, Incontinence/moisture, Nutrition/hydration, Self-management).
Review of the Evidence: A comprehensive literature review indicated that PIs result from prolonged pressure on bony prominences, shear forces, and moisture. Evidence supports that protocol-driven bundles, such as SSKINs, reduce PI incidence in various healthcare environments and across patient populations.
Project Design: This QI project design was based on Deming's Model for Improvement framework focusing on enhancing patient care by standardizing processes. The project team used iterative plan-do-study-act (PDSA) cycles to implement, evaluate, and refine the intervention. OhioHealth Change Management Model tools were used to facilitate stakeholder engagement and develop an effective communication strategy for the project.
Intervention: The SSKINS bundle was implemented through comprehensive staff education. Key components included repositioning every two hours, thorough skin assessments each shift, mobility promotion through rehabilitation medicine, incontinence management with prompt cleaning and barrier cream application, nutritional support with dietary consultations, and patient/family education on self-management techniques.
Significant Findings/Outcomes: The project yielded substantial results, in line with existing literature. In 12 weeks, FAPI incidence rates dropped by 100%, from a baseline rate of (19%) 19 FAPIs per 100 patient admissions to zero. The bundle compliance scores increased significantly, from a baseline rate of 50% to 95%.
Implications for Nursing: The outcomes of using the SSKINS bundle demonstrate the effectiveness of evidence-based practices in PI prevention. This success highlights the critical role of nurses in executing prevention strategies. However, this achievement is not the end. It is crucial to recognize that sustaining these improvements in PI prevention and overall high-quality, patient-centered care requires nurse empowerment through education with skills and resources, engagement, and compliance.
Recommended Citation
Rosario, Carolina, "A Quality Improvement Project to Reduce Facility-Acquired Pressure Injuries" (2024). Doctor of Nursing Practice (DNP) Scholarly Project. 9.
https://fuse.franklin.edu/dnp-project/9
Rights
Copyright, all rights reserved
Included in
Critical Care Nursing Commons, Family Practice Nursing Commons, Geriatric Nursing Commons, Interprofessional Education Commons, Nursing Administration Commons, Occupational and Environmental Health Nursing Commons, Public Health and Community Nursing Commons, Quality Improvement Commons