Date of Award

Summer 2023

Document Type

Final DNP Paper

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Dr. Lori McGrath


Dr. Jessica Crews-Sauk


Background: The clinical gap in service addressed in the DNP project was hospital-acquired pressure injuries. A hospital-acquired pressure injury (HAPI) is a local injury to the skin and underlying tissue during an inpatient hospital stay. The injury is caused by pressure, shear, or both (The Joint Commission (TJC), 2022). The development of a HAPI can result from other factors, such as advanced age, immobility, perfusion issues, nutritional status, illness severity, and chronic conditions (Rondinelli, Zuniga, Kipnis, et al., 2018). Immobile or sedated patients in the intensive care units are the most at risk because they have medical conditions that prevent them from repositioning or result in them spending most of their time in bed or a chair. These injuries can develop in hours or days. The development of a pressure injury while in the hospital negatively reflects the quality of care given by the staff. The healthcare staff must take appropriate measures to ensure patient safety. During a stakeholder’s meeting at a southeastern region medical facility, a consensus was reached that HAPIs were an ongoing issue and needed implementation for an improvement plan. A committee meeting held at the project facility established that at the facility, the metric for HAPIs was at 4% and the national average was 3%.

Purpose: This project aimed to answer the question: In patients at risk for pressure injuries on a medical surgical unit at a Southeastern region facility, how effective will the implementation of an EBP pressure injury prevention bundle as compared to current practice help reduce the number of hospital-acquired pressure injuries in eight weeks?

Methods: A before and after intervention project occurred on a 30-bed medical-surgical unit at a Southeastern region facility for patients at risk for pressure injuries. The implementation of the evidence-based prevention bundle was initiated at admission and audited twice a week over eight weeks. Audits were done to ensure compliance. A prevention team was created consisting of a unit champion, an implementation team (RN, LPN, NA), and WOCN. The Plan Do Study Act method was used to produce a change in the unit and the theoretical model used was Kurt Lewin’s Change theory.

Results: At the end of the eight weeks, the identified patients remained free of pressure injuries. The results of this project revealed the accuracy and effectiveness of the pressure injury prevention strategies used in the bundle that was studied. Adhering to the bundle in its entirety proved to be successful as evidenced by practice improvements implemented with this method at numerous facilities nationwide (Ward, 2020). The project confirmed that when the patient is identified and the bundle ordered at admission, they should not develop a pressure injury. The pre-intervention percentage was 4% and the post-intervention was 0%.

Conclusion: The reviews have shown that the implementation of the prevention bundle has improved HAPIs in several studies. Each study showed a significant reduction in HAPIs postintervention. The strategies must be unit specific but there has been consistency in the interventions used that are most effective. However, teamwork is essential and should be considered before implementing this intervention. The intervention was successful at preventing pressure injuries for those at risk and could be implemented throughout the organization.

Included in

Nursing Commons


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