Effect of a Hospital-Acquired Pressure Injury (HAPI) Risk Score on HAPI Rates in Patients With Vascular Diseases.

Abstract

The purpose of this study was to assess whether a validated hospital-acquired pressure injury (HAPI) risk scale and best practice interventions were associated with lower HAPI rates compared with previous care. We also sought to identify a cut score of HAPI risk when using the instrument. Nonequivalent 2-group pre- and postintervention comparative study. The sample comprised 2871 patients treated for vascular diseases; data were collected on 2674 patients before the intervention and 197 patients postintervention. Their mean (SD) age was 69.3 (12.4) years; 29.3% (n = 842) had a history of diabetes mellitus. Based on discharge status, more patients received home health care after discharge in the postintervention group, 34% (n = 67/197) versus 16.2% (n = 430/2662), P = .001. The study setting was a quaternary care hospital in the Midwestern United States. Patients who were at high risk for HAPI, based on a nomogram score, received a mobility and ambulation program intervention. Pre- and postintervention cohorts were compared using analysis of variance, χ 2 test, and Fisher exact test. A receiver operating characteristic curve plot was generated to determine the ability of the risk score tool to identify HAPI risk at all possible cut points. Despite differences in patient characteristics, primary medical diagnosis, and postdischarge health care needs, the HAPI rate decreased postintervention from 13.8% (n = 370/2674) to 1.5% (n = 3/197), P = .001. A HAPI risk-predicted value cut score of 18 had strong sensitivity (0.81) and specificity (0.81), and positive and negative predictive values of 0.42 and 0.96, respectively. Despite higher patient acuity during the intervention period, HAPI rate decreased after HAPI nomogram and nurse-led mobility intervention implementation.