BlakesAPA5.docx - 1 Quality Improvement: Preventing Hospital Acquired Pressure Injuries Georgenna C. Blakes University of South Alabama College of

1Quality Improvement: Preventing Hospital Acquired Pressure InjuriesGeorgenna C. BlakesUniversity of South Alabama College of NursingNU 450: Leadership and Management Roles for Professional Nursing PracticeDr. Susan G. WilliamsJuly 20, 2020

2Quality Improvement: Preventing Hospital Acquired Pressure InjuriesIndividuals admitted to the hospital anticipate being discharged in a condition that isbetter than which they arrived. Unfortunately, some individuals are adversely affected by eventswhich cause them injury or death. One such incident is the acquisition of stage III and IVpressure ulcers or injuries. A hospital acquired pressure injury (HAPI) is an injury to any area ofthe skin or underlying tissues that occurs as a result of pressure and or shear (Rondinelli, Zuniga,Kipnis, Kawar, Lui, & Escobar, 2018). HAPIs are categorized according to the stage—or level orprogression—of the injury. Stage I injuries consist of persistent redness and bruising; stage IIinjuries consist of shallow, surface openings to the skin; stage III injuries consist of deeperwounds which invade the layer of fat; stage IV injuries go deeper and expose muscle and bone;and some injuries are unstageable because they are either covered slough or a thick black scabcalled eschar (see figure 1), (Anthony, 2018).From the descriptions, one can conclude thatHAPIs are painful injuries that require extensive treatment to heal. In the United States, hospitalacquired pressure injuries affected over 2.5 million people and accounted for over 60,000 deathsin 2019 (Padula et al., 2019). Rules and regulations have been enacted by facilities, federallyfunded agencies and accrediting agencies to reduce and prevent these occurrences. This paperwill discuss how some rules and regulations work to satisfy the Institute of Medicine’s (IOM) sixaims for quality and promote better patient outcomes.The ProblemThere is a proven correlation between prolonged hospital stays and the increased risk forcomplications such as infection, injury and death (McNair, Luft & Bindman, 2009). On average,HAPIs can increase the length of one’s hospital stay anywhere from 4 to 30 days (Dalvand,Ebadi & Gheshlagh, 2018). This time accounts for the additional medications, treatments,

3surgeries and use of medical devices needed for healing pressure injury wounds. Not all patientswho develop HAPIs recover; many suffer additional complications related to operativeprocedures and infection—these complications can quickly lead to death (Padula et al., 2019).Stage I and II pressure ulcers are incidental and can happen within a matter of hours dependingon the amount of pressure and shear involved; stage III and IV pressure ulcers are considerednever-events and must be reported to the Centers for Medicare and Medicaid Services(Rondinelli et al., 2018). Stage III and IV pressure injuries are more complicated and take daysand weeks to form—hospitals are held liable for this negligence and are not reimbursed by theCenters for Medicare and Medicaid Services for costs accrued during the treatment of thesestages of HAPIs (Marquis & Huston, 2017). Over $17.1 billion a year are spent on covering thecosts of preventable medical errors (Van Den Bos, Rustagi, Gray, Halford, Ziemkiewicz &Shreve, 2011).