Hospital Acquired Pressure Injury (HAPI) Prevention: A Bundled Intervention Approach

Abstract

Background: Hospital-acquired pressure injuries (HAPIs) remain a preventable patient safety issue associated with increased morbidity, mortality, length of stay, and healthcare costs. Despite established prevention practices, inconsistent implementation contributes to HAPI development. A microsystem assessment identified gaps related to Braden scale assessment in moisture management, mobility, and friction/shear, along with workflow barriers such as limited repositioning support and supply availability. Methods: This quality improvement project used the Institute for Healthcare Improvement framework and Plan-Do-Study-Act methodology. Process mapping and a fishbone diagram guided intervention design, supported by a focused literature review aimed at adult patients at high risk for skin breakdown. Outcome measures included monthly HAPI incidence via chart audits, with supplementary feedback from staff. Intervention: A bundled intervention included: implementation of a staff-led turn team for repositioning, a supply cart to improve and ensure access to moisture barriers and skin care products, increased availability of positioning aids, and staff education on Braden scale focused prevention strategies. Results: Preliminary findings suggest a reduction in HAPI incidence, improved compliance with repositioning, and increased use of preventative supplies. Evaluation is ongoing to determine sustainability and achievement of the 50% reduction goal. Conclusions: A bundled intervention targeted at Braden Score deficiencies improve prevention, adherence, and reduces HAPI incidence than a single intervention alone. Incorporating structured repositioning support and accessible prevention supplies enhances adherence and supports sustainable quality improvement.