Background: Health Acquired Pressure Injuries (HAPIs) significantly burden healthcare systems by increasing patient morbidity, length of hospital stays, and costs. The Center for Disease Control and Prevention reported that pressure injuries affect more than 2.5 million Americans annually resulting in 60,000 deaths and a financial impact of 11 million dollars. Despite growing awareness and preventive measures, HAPIs remain prevalent across the United States. 

Purpose: The purpose of this quality improvement (QI) project is to reduce the incidence of HAPIs at Level 1 Trauma Center (Bergan Mercy) in Omaha, Nebraska. The secondary aims of the project include improving early identification of HAPIs, enhancing staff education and ensuring adherence to HAPI prevention protocol. Establishing quarterly point-prevalence audits will drive accountability, transparency and continuous improvement. Furthermore, the framework emphasizes the importance of interdisciplinary collaboration and stakeholder engagement in driving process improvement initiatives. 

Methods: A literature review guided the development of evidence-based interventions for HAPI prevention. The findings from the quarterly audits were used following the A3 methodology to perform a root cause analysis to establish an effective intervention to reduce HAPI prevalence and improve adherence to HAPI protocol.  

Outcomes: The results of the quarterly point prevalence audits showed an increased rate of undocumented HAPIs. Additional feedback from surveys of participants in the audit showed that there is a knowledge deficit regarding the appropriate intervention nurses should be implementing to prevent HAPIs. In addition, there was also a lack of documentation about these interventions. The systematic approach combining risk assessment, evidence-based interventions, staff education, and continuous monitoring is expected to significantly reduce the incidence of HAPIs, improve patient outcomes, and enhance overall quality of care. Ongoing commitment and collaboration among healthcare professionals are essential for the sustainability and success of pressure injury prevention efforts.