One of the Medical-Surgical and Telemetry departments, 2 South, was selected to pilot the Hospital Acquired Pressure Injuries (HAPI) reduction effort due to its high rate of HAPI stage 2 and above. A core team was formed to attend the HAPI Kaizen two-day workshop in March 2023. The HAPI Kaizen was the selected approach as it embodied the principles of Highly Reliable Organization (HRO), Human Centered Design and Performance Improvement involving frontline clinical nurses at the center of the design process in creating ideas and standard work solutions to prevent HAPI.
The workshop covered cluster analysis of opportunities and gaps in the system. Initial findings showed that patients missed every two-hour repositioning, inadequate heel protection, improper bed, missed two RN skin checks, delayed wound consultation, and inadequate moisture control. Several performance improvement tools were introduced to equip the nurses for co-designing ideas. These include process mapping, Ishikawa fishbone diagram, brainstorming and Plan-Do-Study-Act.
A significant outcome of the initiative is the 55% reduction in stage 2+ HAPIs compared to baseline rates, achieved as of November 18, 2024. A notable success is observed in the pilot inpatient medical-surgical unit, without a single HAPI event, from July 2023 to September 2024. Initial PDSA cycles demonstrated measurable process improvements, including: 1) Increased compliance in turning and skin checks 2) Adherence Monitoring: Utilization of an adherence monitoring tool showed improvements in several critical areas such as malnutrition screening, medical device-related pressure injury prevention, and pressure-reducing bed surfaces.
