Pressure Injuries

WSHA Hospital Safety & Quality Priorities: Historical Programs 

The WSHA Safety & Quality team is a trusted and collaborative partner supporting Washington hospitals on several key quality and patient safety improvement programs. Historically, WSHA’s initiatives have aligned to support federal programs and support hospitals in achieving national patient safety aims such as: 

When a program achieves milestones, objectives and industry standards of care that are widely adopted in our hospitals, our WSHA Board re-evaluates and re-prioritizes these initiatives. If a program has been successful in reducing patient harm, improving, and sustaining clinical quality outcomes in our hospitals, it may be considered ‘historical’ and no longer a key priority topic area. 

The Safety & Quality team recognizes that tools, resources, and access to materials for these historical programs and are still valuable to our members.

Hospital-acquired Pressure Injuries

Pressure injuries continue to be a top focus in health care, affecting up to 3 million adults each year (IWJ, 2020). Many patients who suffer from pressure injuries are those who also have associated risk factors including malnourishment, multiple devices in use, hemodynamic instability, mechanical ventilation, sedation, immobility and/or are receiving vasopressor medications (JWOCN, 2022) . Following the development of a pressure injury, patients may suffer from severe pain, chronic wound management and even the risk of death. Additionally, an increase of the HAPI severity index is significantly associated with the increased risk of additional hospital-acquired conditions, such as urinary tract infections, venous thromboembolism, and pneumothorax. Moreover, 60,000 patients die each year as a direct result of these pressure injuries. The development of HAPIs can interfere with the patient’s functional recovery which then can contribute to longer hospital stays, severe pain and a potential impact on quality of life.

Recent studies show that the economic burden of HAPIs vary widely, with published literature citing costs between $10-26.8 billion per year in the US (IWJ, 2020). The development of Stage 3 and 4 and unstageable pressure injuries is currently considered by the Washington Department of Health as a Serious Reportable Event. As of 2008, the Centers for Medicare and Medicaid Services (CMS) announced it will not pay for additional costs incurred for hospital-acquired pressure injuries.

Pressure injury prevention requires an interdisciplinary approach to care. Certain aspects of pressure injury prevention care are highly routinized, but the care must also be tailored to the specific risk profile of each patient. Pressure injury prevention can be a shared opportunity to empower patients and their family through education, prevention, and treatment strategies.

Getting Started

Several evidence-based practices have been shown to be effective in reducing the occurrence of pressure injuries. They include:

  • Early identification, including a complete and comprehensive skin inspection by 2 RN’s within 4 hours following admission, transfer, or if the patient is away from the unit for >4 hours.
  • Patient & family engagement in plan of care.
  • A dedicated, multidisciplinary team that meets frequently to identify trends and continuous improvement opportunities.
  • Standardized, evidence-based education to clinical team on how to identify, stage and document pressure injuries.
  • Standardized pressure-relieving surfaces across the continuum.
  • Effective communication and team-based coordinated care.

Tools & Resources

The following toolkits and resources support our hospitals with implementing best practices in the prevention of pressure injuries and draw upon the most current and evidence-based literature.

NPIAP: Free Resource Materials

NPIAP: Position Statement on Staging – 2017 Clarification

NPIAP: Pressure Injury and Stages

NPIAP: Staging Cards for Lightly and Darkly Pigmented Skin

NPIAP: Critical Care MDRPI Prevention

NPIAP: Pediatric Population MDRPI Prevention

NPIAP: Pressure Injury Prevention – PIP Tips for Prone Positioning (NEW)

AHRQ PSI #03 Specifications 

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