Date of Award
Final DNP Paper
Doctor of Nursing Practice (DNP)
Joseph Cook, DNP
Background: Hospital-acquired pressure injuries (HAPIs) adversely affect at-risk patient populations and hospital settings. HAPIs increase the risk of death in vulnerable patient populations (Wassel et al., 2020). In addition, HAPIs cost healthcare agencies $9 to $11 billion annually (Padula & Pronovost, 2018). Inconsistent completion and documentation of the patient’s skin assessments both upon admission and daily throughout their hospital stay are identified barriers to improving patient outcomes. Implementing a Two Nurses, Four Eyes on Skin Assessment model upon admission and daily during the patient’s stay will decrease the incidence of hospital-acquired pressure injuries.
Purpose: The purpose of this Doctor of Nursing (DNP) project is to decrease the incidence of hospital-acquired pressure injuries (HAPIs) by implementing a Two Nurses, Four Eyes on Skin Assessment model. The goal is to initiate a Two Nurses completion of the skin assessment within four hours of admission and every day thereafter. The strategy’s aim is to identify pressure injuries existing at admission and to discern the early onset of pressure injuries to prevent the development of HAPIs in medical-surgical patients.
Methods: The quality improvement project facilitated a team approach to include a Two Nurses, Four Eyes on Skin Assessment model within four hours of admission and a daily skin assessment during the patient’s hospital stay to decrease the incidence of HAPIs in medical-surgical patients.
Results: One hundred fifty-one patients were admitted to the medical-surgical department over an eight-week period. In the post-phase, 11 patients met the inclusion criteria of a Braden Scale score of 12 or less. Within four hours of admission, 100% of the patients had received a Two Nurses, Four Eyes on Skin Assessment. In addition, 100% of the patients received a daily, Two Nurses, Four Eyes on Skin Assessment until discharge. Eighty-five percent (9) of the patients were identified with a pressure injury on admission. One hundred percent of the patients admitted to the DNP project were discharged without a HAPI, including the nine patients admitted to the medical-surgical department with pre-existing skin breakdown.
Conclusion: Hospital-acquired pressure injuries decreased after implementing a Two Nurses, Four Eyes on Skin Assessment model on a medical-surgical unit. In addition, pre-existing or present-on-admission skin injuries were more frequently identified. Hospital-acquired pressure injuries will likely decrease with continued education and implementation of this evidence-based strategy.
Keywords: pressure injury prevention, pressure injury bundles, Two Nurses assessments, hospital-acquired pressure injuries, Braden Skin Assessment Tool, nosocomial infections, stage three pressure injuries, stage four pressure injuries
Bass, Tiffany, "The Use of Two Nurses, Four Eyes on Skin Assessments to Reduce the Incidence of Pressure Injuries in Medical-Surgical Patients" (2023). Doctor of Nursing Practice Projects. 99.