Problem: Hospital Acquired Pressure Injury (HAPI) is a core component of publicly reported score cards that carries steep penalties for poor performance The hospital is at risk of losing its long stay “A” Leapfrog score and risking 2% market basket monetary loss across all admissions.
Measurement: Established a multidisciplinary Performance Improvement team from nursing, education, wound care, nutrition, supply chain, finance, and quality. Team worked in applying Lean Six Sigma DMAIC approach to work towards reducing the HAPI rates by preventing and managing progression of hospital acquired wounds or device related injuries and reaching a sustainable improvement.
Analysis: Abstracted data from January 2019 to December 2021. Control chart to display the HAPI rates before and after pilot started. Total eight HAPI cases in 2020, that reduced to two cases by December 2021. A run chart for data comparison in pilot units. Recommended solutions in a Pareto chart.
Implementation: Enforced two nurses witness skin assessment. Educated nurses on accurately staging and appropriately documenting the wounds. Nutritionists implemented therapeutic protein nutrition powder to promote wound healing for treatment plan. Staff resistance and lack of knowledge to stage wounds. Staff education. Voice of Customer & Kano Model effective tools to utilize.
Results/Discussion: Successfully reduced HAPI rate by more than 20% by 2021. Using estimated direct cost for patients from stage III/IV/unstageable HAPI, we were able to reduce system cost by $250,000 during pilot. Continue to perform skin prevalence and skin assessment. Meeting director for house wide implementation.