Patient Safety Indicator (PSI-3) Project: Reduction in Hospital Acquired Pressure Injuries

Introduction: The goal of the project was to reduce hospital acquired pressure injuries that fall under the PSI-3 criteria set by the Agency for Healthcare Research and Quality in a 500 bed, level 2 trauma, tertiary care hospital. The criteria at the project's time included stage 3, 4, unstageable pressure-related injuries and deep tissue injuries. The rationale was to reduce patient harm and improve the quality of care provided. The project was an executive sponsored multidisciplinary collaborative effort.  Methods:Literature was reviewed for evidence-based prevention interventions. Hospital-acquired pressure injury data, sentinel event reports, wound documentation, nursing unit audits, hospital policies and procedures were reviewed. Data collected was presented to the multidisciplinary groups for discussion. Findings revealed misdiagnoses of pressure injury, inaccurate staging of pressure injuries, excessive ordering of specialty beds, knowledge deficit of skin care products, lack of awareness to positioning of endotracheal tubes, misuse of securement devices, inconsistent prevention measures, variations in documentation and missed consults to the wound care team. Results:Guidelines developed for endotracheal tube care, device related securement devices, COVID-19 skin manifestations, and specialty bed algorithms increased staff knowledge. The electronic health documentation was updated to include guidelines and staging tools to ease documentation burden. Wound photography for early identification of wound etiology was initiated. Staff education on guidelines and audits for monitoring compliance resulted in a reduction of PSI-3 events in four years from 14 to 2 with a parallel decrease in our O:E ratio from 1.64 in 2019 to 0.19 in 2022. Discussion: The project led to a positive impact on pressure injury reduction. The use of photography during the COVID-19 pandemic assisted in establishing early differential diagnosis of COVID skin manifestations. Information gathered regarding the wide scope of causes for purple or ecchymosis of skin was sent to National Pressure Injury Advisory Panel (NPIAP); COVID-19 skin presentation data was sent to the American Academy of Dermatology for further research and development. References: