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Course Name

Clinical Improvement Project II CAPSTONE

Graduation Year

12-2025

Faculty Advisor

Dian Baker

Abstract

Background: Hospital-acquired pressure injuries (HAPIs) are a major quality and safety concern, particularly in the intensive care units (ICUs) where critically ill and immobile patients face elevated risk. At Sutter Medical Center Sacramento (SMCS), nine confirmed HAPIs and two under investigation were reported within the medical ICU, cardiac ICU, and neurosurgical ICU by May 2025, exceeding the hospital’s target and prompting a system-wide quality improvement initiative.

Aim: The aim of this project was to: (a) reduce ICU-acquired HAPIs to fewer than four cases per quarter by December 2025 and (b) increase nursing compliance with early and ongoing prevention strategies, including repositioning, nutrition optimization, and risk assessment accuracy.

Methods: Guided by the Iowa Model Revised, this quality improvement project was implemented across the Cardiac (CICU), Medical (MICU), and Neurosurgical (NSSICU) ICUs. Interventions included: (1) staff education, (2) Wound Champion designation, (3) wound care supply room reorganization, (4) nutritional supplementation with Juven and enteral feeding catch-up protocols, (5) wedge repositioning trials that led to full implementation, and (5) beta testing of the Braden and Cubbin–Jackson (CJ) scales for enhanced risk identification. In addition, beta-test data from the Leaf and Atlas mobility monitoring systems were collected to assess repositioning adherence but not adopted for routine use. Enteral feeding data was verified through EPIC chart audits and bedside rate checks, documented in Excel for trend analysis.

Results: Among 22 ICU patients assessed, the CJ scale identified 55% as moderate to high risk compared with 18% using the Braden scale, suggesting improved sensitivity for critically ill patients. Leaf system data showed high repositioning adherence (87% and 84.7%), while nutrition audits revealed declining compliance with Juven implementation and documentation (58.8% → 20% → 0%) and enteral feeding catch-up goals. As of October, a total of twenty-one HAPIs were reported across three ICUs, with an estimated 33.6 HAPIs prevented during the reporting period.

Conclusion: Integrating evidence-based interventions strengthened prevention practices and early risk recognition. Sustained progress will require leadership engagement, standardized audit tools, and policy integration of nutritional and positioning protocols to maintain improvements in patient safety.

Keywords

Hospital-acquired pressure injury, Intensive care unit, Quality improvement, Repositioning, Nutritional support, Risk assessment, Evidence-based practice, Iowa Model, Pressure ulcer prevention, Cubbin-Jackson Scale, Braden scale, Wound care, Enteral nutrition, Enteral feeding

Staying Ahead of the Pressure: A Multimodal Intensive Care Unit Hospital-Acquired Pressure Injury Quality Improvement Project at Sutter Medical Center, Sacramento

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