D221 Final Paper: Practice Improvement Plan for Pressure Injury Prevention

Student Name

Western Governors University

D221 Organizational Systems and Healthcare Transformation

Prof. Name:

Date

D221 Practice Improvement Plan Proposal

Situation (S)

Healthcare-Related Situation

Implementing effective turning protocols for immobile hospitalized patients is essential. Without proper management, pressure injuries can lead to significant discomfort, severe complications such as infections, and longer hospital stays. These injuries also complicate discharge planning, delay recovery, and increase the risk of readmissions, thus affecting overall patient outcomes and healthcare efficiency.

Background (B)

A2a: Data

Hospital-acquired pressure injuries (HAPIs) serve as a crucial quality metric across healthcare systems in the U.S., underscoring the urgent need for better prevention and monitoring strategies in nursing care (Tervo-Heikkinen et al., 2023). Over 2.5 million Americans suffer from pressure ulcers, which are painful skin lesions prone to infection and increased healthcare use. The Agency for Healthcare Research and Quality (AHRQ) introduced a pressure injury prevention toolkit in 2012, aimed at reducing these injuries through evidence-based strategies like regular skin assessments, timely patient repositioning, and education on risk factors. This toolkit fosters teamwork among nurses, physicians, and wound care specialists to promote patient safety and comfort.

A2b: Patient Safety Standards

According to the Joint Commission’s National Patient Safety Goal (NPSG.14.01.01), pressure injuries are preventable. Proper use of clinical guidelines enables early identification of at-risk patients and timely interventions. Hospital staff should use risk assessment tools, such as the Braden Scale, and implement preventive actions like maintaining skin cleanliness, reducing friction and shear, and repositioning patients effectively to enhance tissue tolerance.

Assess (A)

A3: Impact

Pressure injuries impose substantial financial burdens on hospitals, requiring costly resources such as specialized dressings, advanced support surfaces, extra nursing care, and medications. These added expenses strain healthcare budgets and divert resources from other patient care areas, negatively impacting the overall quality and efficiency of care.

A3a: Value

Developing a pressure injury during hospitalization can be life-threatening and prolong treatment duration, complicating patient recovery. For healthcare staff, managing these injuries increases workload through more frequent monitoring, treatment, and documentation, which adds to staff strain.

Evidence-Based Practice Change

A4a: High-Reliability Organization

Adopting a pressure injury prevention protocol can standardize care across hospital departments. Utilizing assessment tools to identify at-risk patients and enforcing regular repositioning schedules ensure early and consistent preventive measures. This approach aligns with the high-reliability organization principle of proactively managing potential risks (Khan & Jonusas, 2019). Research supports repositioning patients every two hours as an effective way to reduce pressure injuries. Following recommendations from AHRQ and the Joint Commission fosters a culture of safety and high reliability.

A4b: Barriers

Two major obstacles include scheduling conflicts due to unit demands and patient refusal to comply with repositioning schedules.

A4c: Interventions

To overcome scheduling conflicts, specific staff members can be trained and assigned to manage repositioning tasks rather than distributing this responsibility among all nursing staff. Addressing patient refusal requires involving patients in their care plans, allowing them to express preferences and fostering collaboration, which increases compliance and enhances outcomes.

A4d: Shared Decision-Making

Encouraging teamwork between nurses and physicians is critical to developing shared goals for skin integrity. Unlike task-oriented models, a team-based nursing model designates clear roles for repositioning and scheduling to avoid missed turns. This promotes a collaborative environment that improves communication and patient care continuity.

A4e: Outcome Measures

To measure success, hospitals should track the incidence of pressure injuries before and after implementing turning schedules. Compliance can be monitored via nursing documentation audits. Collecting feedback from nursing staff on protocol challenges can guide future adjustments to improve implementation.

A4f: Care Delivery Model and Impact

Currently, pressure injury prevention relies on task-focused care. Moving to a team-based model assigns distinct roles to managers, nurses, and nursing assistants. Managers and charge nurses coordinate tasks and monitor documentation, while nursing staff execute scheduled turns. This approach is expected to enhance care quality, foster collaboration, improve communication, and ensure continuity of care.

Summary Table: Barriers and Interventions for Turning Schedule Implementation

Barrier	Intervention
Schedule conflicts on unit	Train and assign specific staff to manage patient repositioning
Patient refusal to comply	Engage patients in care planning to respect preferences

References

Agency for Healthcare Research and Quality. (2017). Pressure injury prevention in hospitals training program. https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureinjury/index.html

Khan, M., & Jonusas, E. (2019). Turn teams: How do you prevent pressure injuries? MEDSURG Nursing, 28(4), 257–261.