Coauthored by Angela Pascale, Research Analyst, Press Ganey.
Hospital-acquired pressure injuries (HAPI) are a significant clinical concern. Not only do they negatively impact patients’ quality of life, but they can substantially increase health system costs as well. With an estimated average cost of $11,000 per HAPI, the U.S. spent a staggering $26.8 billion to treat HAPI in 2018. Moreover, the development of pressure injuries can interfere with a patient’s functional recovery due to pain, infection, and other complications.
One thing we’ve learned: Nursing care is integral to pressure injury prevention.
Nurses’ mission-critical role in preventing pressure injuries
Nurses play a fundamental role in identifying patients who are at risk of developing pressure injuries (PIs), as well as initiating evidence-based nursing interventions to prevent the development of pressure injuries.
Pressure injuries are categorized according to the extent of tissue damage into four stages (stage 1 through stage 4) and the most severe classifications of unstageable pressure injury and deep tissue pressure injury (DTPI). Identifying patients at risk for developing PIs and implementing prevention interventions early reduces the severity and progression of pressure injuries. This is of particular importance as greater severity is associated with increased patient burden and significantly higher treatment costs.
Several evidence-based nursing interventions currently exist to prevent HAPIs from developing and to reduce the severity of the pressure injury stage. The first step is to routinely assess patients, beginning with admission, to identify those likely to develop pressure injuries. Prevention interventions—like routine repositioning, nutritional support, moisture management, and pressure redistribution—should be initiated as soon as at-risk patients are identified. Unfortunately, HAPIs continue to affect millions of people, and current research on preventative practices for at-risk patients remains limited.
Pressure injury prevention interventions in U.S. acute care hospitals
We completed an analysis using Press Ganey’s National Database of Nursing Quality Indicators (NDNQI) to better understand how prevention interventions were used among at-risk patients.
Our sample included data from 355,031 at-risk patients in 1,379 acute care hospitals. We first classified at-risk patients into three categories:
- Those with no evidence of PIs
- Superficial PIs (stage 1 and stage 2)
- Severe PIs (stages 3 and 4, DTPI, and unstageable)
We then determined the frequency of the four prevention interventions: routine repositioning, nutritional support, moisture management, and pressure redistribution for patients in each at-risk group.
Over 95% of at-risk patients had no pressure injuries.
In the study sample, only 1.6% (n = 5,679) of patients had superficial PIs, and 2.2% (n = 7,821) of patients had severe PIs, with the remaining sample (96.2%; n = 341,531) reporting no pressure injuries. This is likely due to nursing’s consistent implementation of pressure injury prevention interventions, illustrated in the figure below.
- Pressure redistribution implemented in 91.9%–95.4% of patients
- Moisture management implemented in 92.4%–95.0% of patients
- Routine repositioning implemented in 85.0%–88.6% of patients
- Nutritional support implemented in 78.6%–90.4% of patients
Press Ganey client hospitals report significant adherence across all nursing interventions known to reduce the prevalence of pressure injuries
Our findings demonstrate nursing’s consistent adherence to pressure injury prevention practices for at-risk patients across Press Ganey client hospitals. The use of pressure redistribution bed surfaces and moisture management were implemented the most consistently across all three PI groups. Our findings also suggest that areas for improvement include more consistent nutritional support and routine repositioning.
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