Each year, as part of Brigham and Women’s Faulkner Hospital’s ongoing commitment to providing the safest, highest quality care to our patients, departments across the hospital are charged with developing and implementing their own Quality Assurance Process Improvement (QAPI) plan. This year, the 6 North team, led by Nurse Director Suzelle Saint-Eloi, MS, RN, Professional Development Manager Susan Belton, MSN, BS, RN, CNL, and Program Manager for Wound Ostomy Continence Care Cody Hedglin, MSN, RN, CWON, is piloting HAPI rounds in order to improve care for patients with pressure injuries.
“HAPI stands for hospital-acquired pressure injuries. It’s what’s commonly called a bedsore,” explains Saint-Eloi. “We find patients who have trouble changing position on their own are the most at risk for HAPI, which typically occur on the heels, ankles, hips and tailbone. It’s something we are continuously focused on. We want to prevent HAPI from occurring and also provide the best possible treatment when they do occur.”
As part of a collaborative effort with Nursing Professional Development (Belton and Hedglin), Nursing Quality (Program Manager for Nursing Quality and Magnet Rose LaPlante, MBA, MSN, RN, NEA-BC) and the 6 North wound champion (clinical nurse Ella Haines, RN, BSN), the team decided to implement a pilot of HAPI rounds after it was identified as an area of concern during the hospital’s mock Joint Commission survey.
“We have multiple tools available for staff use that guide best practice for the care of patients at risk for HAPI. But the mock survey identified gaps in the use of these tools along with the timeliness of obtaining official wound care orders,” says Hedglin. “On 6 North, we decided to implement the rounding project, which involves focused weekly rounding on specific patients to look at the identified pressure injuries and do bedside education with all present members. We discuss topics such as pressure injury staging, wound treatment(s), wound care documentation and wound orders. We discuss and analyze the use of our available pressure injury tools, such as image capture via Rover, our pressure injury staging tool, and the use of safety reports. If any changes to the patient’s medical record need to be made to better reflect the pressure injuries and their management, we do that in real time at the bedside.”
In addition to the patient’s nurse and PCA, Saint-Eloi, Hedglin and Belton, HAPI rounds are attended by Executive Director of Nursing Professional Development, Practice and Innovation Colleen West, DNP, MBA, RN, CPHQ, LaPlante and Haines, who communicates with her colleagues on the unit any trends that were identified.
“Through our assessment, we determine if in fact it is a pressure injury, if the staging is correct and identify interventions to be put in place. With the nurse, in real time, we take new pictures, document in the medical record and answer any questions they may have. This pilot program has helped us stay on top of pressure injuries and make sure proper interventions are put in place, actual orders for wound care are being placed by the providers, new pictures are being taken (especially if the patient has a lengthy stay) and, in some cases, fix the staging to a ‘skin at risk’ and not an ‘injury,’” says Haines. “I feel that we have also been able to provide our floor with better wound care education and information regarding resources to improve prevention and care.”
“I’m very pleased with how well our pilot program has gone so far,” says Belton. “Pressure injuries can be very difficult to treat and cause the patient a lot of pain. Anything we can do to avoid that discomfort, and risk for infection, is helpful. And the more our staff know about HAPI, the more they can stay on top of it.”
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