Innovate to Elevate: Reducing Pressure Injuries

Introduction: Hospital-acquired pressure injuries (HAPIs) remain a critical challenge in healthcare, affecting over 2.5 million patients annually in the United States and contributing to 60,000 deaths. A 53-bed inpatient rehabilitation and brain injury unit experienced elevated HAPI rates in FY23, with 62% of reported cases being heel-associated. Root cause analysis revealed contributing factors such as darkly pigmented skin, inconsistent pressure relief interventions, and lower extremity sur- geries. A proactive, targeted intervention was developed to address these risks and reduce HAPI rates. Methods: A six-month proactive heel HAPI prevention plan was implemented. Interventions included: (1) Enhanced education on heel floating techniques and real-time process reinforcement; (2) Targeted visual assessments for patients with Braden Scores ≤18 and recent lower extremity surgeries; (3) Introduction of a clinical “Decision Tree: Heel Pressure Injury Prevention” tool; (4)Implementation of two licensed personnel skin checks following patient leaves of absence ≥24 hours; (5) Training on evidence-based assessment techniques for darkly pigmented skin. Outcome measures included compliance with heel observation protocols, adherence to skin assessments, and monitoring of heel-specific and overall HAPI rates. Data were collected and analyzed to assess the effectiveness of these interventions. Results: The unit achieved a 76.92% reduction in overall HAPI rates, with heel-associated HAPIs reduced to a single case in FY24. Daily heel observation compliance exceeded target benchmarks, and admission skin assessments by two licensed personnel improved consistency in early detection and intervention. Discussion: This structured, proactive approach demonstrates the effectiveness of targeted interventions in reducing HAPI rates. The inclusion of education, interprofessional collaboration, and a clinical decision-making tool provided sustainable improvements in care. Special attention to vulnerable populations, such as patients with darkly pig- mented skin, was critical in achieving these outcomes. This model can be replicated across similar settings to address HAPI challenges and improve patient safety and outcomes.