HAPI Reduction Plan: Flipping the Pyramid to Achieve a Nursing Quality Goal

L. to R., Laura L. Hernandez, Nicole Walkowiak, Lisa BoudreauL. to R., Laura L. Hernandez, Nicole Walkowiak, Lisa Boudreau

Lisa Boudreau, MSN, RN, CWOCN, Laura L. Hernandez, BA, BSN, RN, CWON, Nicole Walkowiak, BSN, RN, CRRN, CWOC

In July 2018, with the support of nursing senior leadership (NSL), the wound, ostomy, and continence nurses (WOCN) utilized resources and processes to create a monthly incidence report for hospital-acquired pressure injury (HAPI) incidence that resulted in a sustained decline in pressure injuries.

HAPIs are a key nurse-sensitive quality indicator. Historically, HAPI rates were assessed through quarterly prevalence surveys. With a Skin Oversight Committee (SOC) and individual unit SWAT teams, the HAPI goal was consistently met. In early 2018, there was a surge of HAPIs, resulting in a rate above the national benchmark. The trended data surge indicated that our current HAPI prevention plan needed to be reevaluated.

The SOC leaders met with NSL and identified the following structural challenges: difficulty obtaining pertinent data, inconsistent SWAT team participation, and lack of unit follow up.

Strategies to be implemented included the creation and distribution of a monthly HAPI incidence report in addition to the quarterly prevalence surveys. The SWAT teams now conduct a clinical quality case review for all HAPIs to identify gaps in practice and implement a corrective action plan. The first case presented occurred in July 2018 after months of gathering data. The cases are presented on a recurring monthly base by the SWAT members at the SOC meeting; they have within 30 days to follow up.

Due to the availability of the incidence data, 105 HAPI cases were identified over 16 months, from January 2018 to May 2019. The cases were presented by the SWAT members to SOC, and unit-based action plans were implemented within 30 days.

In response to more timely data, the individual HAPI cases sustained a reduction from a peak of 2.49% to rates regularly below 1%. Rush’s HAPI rates have consistently exceeded our institutional goal and are below the national benchmark mean.

Through NSL support, a plan was implemented that addressed unit HAPI trends in a timely manner. This achievement for the internal HAPI goal exemplified transformational leadership, providing resources to empower clinical nurses to complete HAPI case reviews and cultivate a plan for change.

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