Title : Improving hospital-acquired pressure injuries in acute care
Abstract:
Background/Clinical Problem: Hospital-acquired pressure injuries (HAPIs) impact 2.5 million patients annually. HAPIs are sustained when blood flow is restricted to bony prominences from shear, friction, or prolonged pressure and result in damage and ulceration of skin.
PICO Question/Purpose: In adult medical-surgical patients who are at risk for hospital- acquired pressure injury development with a Braden score of 18 or less, would (P) implementation of the Standardized Pressure Injury Prevention Protocol (S-PIPP) 2.0 Checklist and a nurse-driven skin champion education series (I) compared to routine pressure injury prevention (C) reduces the medical-unit HAPI rates (O) over a 90-day period (T)?
Methods: This quality improvement initiative compares HAPI prevention practices with a structured prevention bundle incorporating the S-PIPP 2.0 tool, engagement of nursing staff, and collaboration with wound care specialists. A post implementation sample of 103 patients, who met inclusion criteria, over three months are included. Chart reviews captured demographics (age, sex), prevention bundle utilization, and Braden scores. Pre- and post-implementation chi-square analysis compared the utilization of prevention strategies, patient outcomes, and HAPI incidence. An a priori power analysis using G*Power indicated that a medium effect size, power of 0.80, and alpha of .05 was achieved.
Results/Findings: Pre-implementation chart audits were collected over a 90-day period from October to December 2025 to obtain a baseline (n= 97). Post- implementation, data collection was obtained from January to April 2026 (n=103). Utilization of prevention bundle elements were monitored and varied for each patient. A chi-square test of independence was conducted to examine the association between the pre- and post-intervention periods and the utilization of the HAPI prevention bundle. Overall, we fail to reject the null hypothesis as the results were not statistically significant.
Implications for Practice/Conclusions: Implementation of the nurse-led education, the S-PIPP 2.0 checklist, and standardized prevention bundle did not show significant change when enhancing pressure injury prevention practices by float pool nurses. However, a longer study and the utilization of the six-sigma method may be a stronger design to collect more accurate data over time.
