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Culture shift helps YNHH make headway against HAPIs

For those who don’t provide direct patient care, bed sores might not seem like the most serious of problems, especially for patients hospitalized for other, significant conditions.

But hospital-acquired pressure injuries (HAPIs), as they’re officially called, are considered a major health issue nationwide. Annually, more than 2.5 million people in the U.S. develop these skin lesions, which can cause pain, increase patients’ risk for serious infections, require additional treatment and result in longer hospital stays.

Like other U.S. hospitals, Yale New Haven Hospital has long worked to reduce HAPIs, and in 2018 had “phenomenal results,” said Jennifer Ghidini, RN, director of nursing, Medical Critical Care.

From 2014 to 2018, the hospital reduced HAPIs from around 4 percent to 1.3 percent, by implementing a comprehensive prevention strategy that includes rounding, new patient-care protocols and procedures, staff education, auditing and other measures. The HAPI-prevention strategy was developed by an interdisciplinary Healthy Skin Steering Committee that was restructured in 2014. “So many different elements go into preventing pressure injuries, we wanted to include a broader mix of experts on the committee,” Ghidini said.

The committee includes a nurses from a variety of roles, physicians, an advanced practice provider and wound clinicians. It also includes physical therapists, who provide expertise on patient mobility; Corporate Supply Chain representatives, who assist with products and equipment; dietitians, who advise on proper nutrition and hydration; and staff from Information Technology Services, who help create order sets for HAPI-prevention measures. Respiratory therapists are also important team members, since devices such as oxygen masks and tubes can cause pressure injuries.

These different aspects of HAPIs are often covered during prevention rounding, said Corinne Signore, RN. For rounds, she and other wound-care clinicians identified patients at high risk for HAPIs and, with unit nurses, performed head-to-toe assessments. They looked for gaps in care, asking questions such as, are the correct supplies or equipment being used? Are patients being repositioned enough? Have patients had nutrition consults?

Last year, wound-care clinicians developed an online survey that unit staff now complete on their own. This gives unit staff autonomy and promotes collaboration on the units, Signore said. Wound-care clinicians review survey results each month to identify and fix persistent problems – for example simplifying the process for ordering special equipment or educating staff.

“Through rounding and online surveys, we can identify trends and try to implement solutions to prevent HAPIs in the future,” Signore said.

All of the HAPI strategies have one thing in common, according to Ghidini.

“We switched from a reactive mode, in which we focused on treating pressure injuries, to a preventive mode,” she said. “It was a shift in practice and a shift in the culture, and it’s making a difference.”