Increased Rate of Hospital-Acquired Pressure Ulcers


The topic of the given capstone project is the increased rate of hospital-acquired pressure ulcers (HAPUs) in the US. I am studying the practice problem of HAPUs so that I can help my organization make a difference for patients and their families attempting to address this issue. This topic is relevant as pressure injuries place a great burden on people as they suffer from permanent pain caused by skin lesions and are subject to an increased risk of getting a serious infection.

Problem Description

I would like to examine the incidence rates of HAPUs because prevention of this condition is viewed as the critical patient safety indicator and a challenge faced by the US healthcare organizations (Clark et al., 2014). I will examine the rates of HAPUs in Kings County Hospital Center and assess the data by comparing it with the state benchmark set by the New York State Department of Health.

Since the hospital’s mission is the provision of safe and high-quality care to patients, this project will add value to Kings County Hospital Center by identifying potential areas for quality improvement and giving some recommendations as to how to enhance patient care. This project aligns with my future career goals by providing me with the opportunity to lead in exploring and assessing a real-world healthcare problem of pressure injuries in the healthcare setting.

Problem Statement

Kings County Hospital Center has 3.3 PU rate during October 2014 – October 2015, as compared to the state benchmark of 1.32 set by the New York State Department of Health (New York State Department of Health, 2016). Key performance indicators are the incidence and prevalence rates of pressure injuries, as well as the length of hospital stay (Kwong, Lee, & Yeung, 2016). Outcome measures are decreases in the incidence and prevalence rates of category 2, 3, and 4 pressure ulcers, as well as a decrease in the length of hospital stay.

Literature Review

The aging of the population, coupled with poor quality of care, makes the incidence and prevalence rates of HAPUs grow. In the US, the incidence rate of pressure injuries currently stands at 30% per thousand discharges (Pickham et al., 2018, p. 13). Such an alarming percentage may also be explained by the utilization of protocols that are not guided by the best evidence-based practices, as well as high costs of adoption of appropriate technological equipment, such as patient motion sensors and specific support surfaces (Kwong et al., 2016). Patients that develop pressure injuries in the hospital setting are linked with higher mortality rates and longer length of stay (Wilborn, 2015).

More than 60,000 patients die annually due to complications of the condition (Shi, Dumville, & Cullum, 2018, p. 2). These statistics highlight the need for a thorough critical assessment of the performance of a single hospital-based on the set benchmark in order to evaluate how effectively it tackles the chosen practice problem.

It is worth mentioning that pressure injuries are associated with serious economic concerns. HAPUs cost the US healthcare system an estimated $9-11 billion annually (Padula et al., 2018, p. 133). However, apart from costs related to treatment, HAPUs may also result in litigation (Roberts et al., 2017). Considering the discontinuation of reimbursement for HAPUs, enormous stress is placed on hospitals to prevent the incidence of this costly condition, not to mention daunting financial implications for patients.


Given the negative impact of pressure injuries, it is important to assess the quality of care provided by healthcare organizations using incidence and prevalence rates of PUs as key performance indicators. By comparing these rates with the state average, conclusions can be made whether the organization underperforms or outperforms the benchmark. Such an assessment may be the primary point in the elaboration of new pressure ulcer prevention care bundles based on the best evidence-based practices.


Clark, M., Black, J., Alves, P., Brindle, C., Call, E., Dealey, C., & Santamaria, N. (2014). Systematic review of the use of prophylactic dressings in the prevention of pressure ulcers. International Wound Journal, 11(5), 460-471.

Kwong, E. W., Lee, P. H., & Yeung, K. (2016). Study protocol of a cluster randomized controlled trial evaluating the efficacy of a comprehensive pressure ulcer prevention programme for private for-profit nursing homes. BMC Geriatrics, 16(1), 20-27.

New York State Department of Health. (2016). Pressure ulcer. Web.

Padula, W. V., Pronovost, P. J., Makic, M. B. F., Wald, H. L., Moran, D., Mishra, M. K., & Meltzer, D. O. (2018). Value of hospital resources for effective pressure injury prevention: A cost-effectiveness analysis. BMJ Quality & Safety, 28(2), 132–141.

Pickham, D., Berte, N., Pihulic, M., Valdez, A., Mayer, B., & Desai, M. (2018). Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). International Journal of Nursing Studies, 80, 12-19.

Roberts, S., Wallis, M., Mcinnes, E., Bucknall, T., Banks, M., Ball, L., & Chaboyer, W. (2017). Patients’ perceptions of a pressure ulcer prevention care bundle in hospital: A qualitative descriptive study to guide evidence-based practice. Worldviews on Evidence-Based Nursing, 14(5), 385-393.

Shi, C., Dumville, J. C., & Cullum, N. (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLOS One, 13(2), 1-29.

Wilborn, W. (2015). Pressure ulcer prevention strategies. Nursing Made Incredibly Easy, 13(6), 10–12.