UAB Hospital, Birmingham, AL.
J Healthc Qual. 2023;45(3):125-132. doi: 10.1097/JHQ.0000000000000371. Epub 2023 Jan 16.
Hospital-acquired pressure injuries (HAPIs) continue to increase in comparison to other hospital-acquired conditions, despite advancements in prevention and wound care practices. In 2017, an interprofessional skin team (IST) was formed at an academic medical center to improve patient care and reduce HAPIs. Intentional wound, ostomy, continence (WOC) nurse rounding coupled with IST efforts steadily decreased HAPIs in the organization by 39%. In an effort to continue to improve care, a root cause analysis (RCA) of HAPIs was initiated in two intensive care units (ICUs) in October 2019. Using the Plan-Do-Study-Act model, two WOC nurses and a nursing professional development specialist from the IST developed the HAPIs RCA process. Rapid cycle process improvement demonstrated the need to transition from a paper form to an electronic process to increase accessibility for all nursing units and patients to benefit. In May 2020, an electronic reporting system for RCAs for HAPIs began. After implementation, there has been a 53.5% reduction in HAPIs over 2 years. The standardized, electronic RCA process has resulted in improvement, dissemination of best practices, and fostering nonpunitive accountability for each unit's HAPIs.
与其他医院获得性疾病相比，医院获得性压疮（HAPI）不断增加，尽管在预防和伤口护理方面取得了进步。2017 年，一家学术医疗中心成立了一个跨专业皮肤团队（IST），以改善患者护理并减少 HAPI。有目的的伤口、造口、肠造口术和失禁（WOC）护理查房加上 IST 的努力，使该组织的 HAPI 减少了 39%。为了继续改善护理，2019 年 10 月在两个重症监护病房（ICU）启动了 HAPI 的根本原因分析（RCA）。使用计划-执行-研究-行动模型，两名 WOC 护士和 IST 的一名护理专业发展专家制定了 HAPI RCA 流程。快速循环流程改进表明，需要从纸质流程过渡到电子流程，以增加所有护理单元和患者的可及性，使他们受益。2020 年 5 月，开始实施 HAPI 的 RCA 电子报告系统。实施后，2 年内 HAPI 减少了 53.5%。标准化的电子 RCA 流程带来了改进、最佳实践的传播，并为每个单位的 HAPI 建立了非惩罚性的问责制。
