Mandy Halvorson

Position: Nurse practitioner UW Health Northern Illinois- Swedish American wound care center

Scholarly Project Advisor: Teresa K. Novy DNP, GERO-BC, CNEcl, CWON

Affiliated Health System Where Project Occurred: UW Health Northern Illinois- Swedish American

Funding you received: None

External Dissemination of the Project:
2025 Illinois State University (ISU) Research Symposium
2025 ISU Mennonite College of Nursing (MCN) DNP Intensives
Advanced Practice Provider meeting presentation
Shared Governance Committee presentation
Submission to Journal of Wound Ostomy Continence Nursing – Pending review

Introduction/Problem

As a leading cause of unintentional medical harm, hospital-acquired pressure injuries (HAPI) cause unnecessary patient suffering while creating increased risk for mortality or condition deterioration (Bronk, 2023). Wound care professionals at a midwestern hospital recognized increasing HAPI rates among hospitalized adults prompting process change initiation. Driven by evidence-based practice recommendations, the Standardized Pressure Injury Prevention Protocol Adult 2.0 (SPIPP) is an in-depth risk assessment checklist that was used as the intervention protocol for this quality improvement project (National Pressure Injury Advisory Panel, 2023).

Methods

Three inpatient hospital units were used for the control group and three for the intervention group. The control group maintained regular daily nursing functioning with the use of the Braden scale. The intervention group participating in an educational session prior to the implementation period, receiving education on the prevention and management of pressure injuries and instruction on use of the SPIPP checklist. Bedside nursing staff of the intervention group completed the SPIPP checklist daily on every patient for a 3-month period during the first quarter of 2025. A retrospective analysis of pressure injury incidence rates was performed for the quarter prior to intervention with direct comparison to pressure injury incidence rates during the intervention period. Nursing knowledge was evaluated during this quality improvement project with the use of Qualtrics™ surveys completed prior to the education session, following the education session, and upon completion of the intervention period.

Findings

Mean HAPI incidence rates of the intervention units reduced from 0.254 in the pre-intervention period to 0.083 during the intervention period. There was not significant change in the mean incidence rates of the control group. A paired-T test was used where t (8) = 2.536, p 0.035 with an alpha of 0.05 indicating a significant reduction in HAPI with the use of the SPIPP checklist. Nursing knowledge improved with average test scores increasing from pretest at 62%, posttest at 73%, and the final test at 76% correct but did not indicate statistical significance when further evaluated. Limitations of this study included a small sample size, short duration, and single study site.

Practice Implications

The correlation between daily SPIPP checklist use and reduction in HAPI incidence rates supports integration of the checklist into the electronic medical record for system-wide practice. The SPIPP checklist is developed from evidence-based practice guidelines from the National Pressure Injury Advisory Panel and endorses improved prevention intervention use which relates to reduced adverse occurrences. Limitations in this quality improvement project stimulated future process change with enhanced documentation needs and further nursing continued education.

References

Bronk, K. (2023, October 10). The Joint Commission releases quick safety advisory on early identification and evaluation of severe pressure injuries. The Joint Commission. https://www.jointcommission.org/resources/news-and-multimedia/news/2023/10/quick-safety-advisory-on-early-identification-and-evaluation-of-severe-pressure-injuries.

National Pressure Injury Advisory Panel. (2023). International guidelines. https://internationalguideline.com/the-international-guideline.