Hospital Acquired Pressure Injuries

Hospital Acquired Pressure Injuries

Hospital Acquired Pressure Injuries (HAPI) are also referred to as pressure ulcers which are mostly very expensive but preventable. It is important to define what a pressure injury is in order to be able to reduce HAPI in health care institutions. The National Pressure Ulcer Advisory Panel indicates that a pressure injury is a localized damage to the skin situated under a soft tissue usually above a bony prominence. The injury can significantly affect the health outcomes of patients. The rate of HAPI incidents has been decreasing in the U.S but the situation is not entirely eliminated. The following paper aims at revising the PICOT question that was discussed in the topics part 1 and part 2, qualitative and quantitative article critique and identifying the practice problem based on the PICOT question. The paper will discuss how the PICOT question is related to the nursing practice problem and the research articles.

PICOT Statement

The problem

Health care institutions across the United States have recorded a decrease in HAPI cases but despite the decrease the situation has not been entirely addressed. HAPI are common among patients who are bedridden, those who are using wheelchairs and those wearing medical equipment. Pressure ulcers can develop to all individuals despite their age. Pressure ulcers are as a result of various factors such as hormonal changes, impaired blood proliferation and decreased immune protection (Engels, 2016). Due to the fact that pressure ulcers reduce the outcomes of patients, it is important that the situation is reduced to a great extent and if possible eliminated. Therefore, this study discusses the most effective strategy of reducing pressure ulcers.


The recommended intervention in the study is to use pads to protect bony areas. PU cases are mostly common for elderly patients who are suffering from chronic illnesses which require greater awareness of therapeutic and preventive measures (Frain, 2018). Other measures to reduce pressure ulcers include: nurses should also ensure the patients’ skin is clean and dry. The cleaner and dry the skin is, the less the possibility of PU development. Again, patients in healthcare facilities should be provided with pillows. The pillows can be put in between various parts of a patient’s body therefore preventing pressure ulcers. The NIH recommends patients should place a pillow under the shoulders, elbows or heels. Exercise is also another great strategy to reduce pressure sores. Pressure sores are more likely to occur when a patient never gets out of bed and considers the idea of exercising intimidating (Padula, 2017). Exercise can be conducted even when a patient is in bed by simply performing motion exercises. An example of a motion exercise is lifting one’s arm for approximately 10 seconds then repeating the same with the other arm. Generally, these strategies reduce the possibility of pressure ulcers developing among patients.


The intervention of using pads to protect bony areas will be compared with a situation whereby it is not adopted to address the problem of pressure ulcers. It would be anticipated that patients are more likely to acquire pressure ulcers without the interventions.

Outcome and time

The pads will absorb moisture and get it away from the patients’ skin therefore decreasing the possibility of acquiring pressure ulcers. The pads should be situated on areas such as the knees, heels and hips. The pads utilize air and fiber as well as other crucial components to be able to absorb the moisture and keep the skin dry. Positive outcomes will be as a result and increased use of pads on bony areas. The results will be determined after a period of four-week period.

The PICOT question: Within the specified population, what is the impact of using pads on bony areas to prevent pressure ulcers compared to not using them within a four-week period?

Swan, J. (2018). Use of dermal gel pads in preventing and managing pressure ulcers in ICU: an audit. British Journal of Nursing27(20), S42-S47.


Background of the study

According to Swan (2018), a majority of pressure ulcers are majorly as a result of the medical equipment patients wear. Using a dermal pad was recommended as an efficient strategy to prevent pressure ulcers. However, various healthcare professionals indicated a dermal pad was more likely to tear and suggested an alternative gel pad to be used. Afterwards an audit of four weeks was carried out to determine the impact of a gel pad on 37 patients who were recuperating in the ICU. The PU prevention strategy was not changed; only the pads were changed. The author indicated that a lot of research has been conducted on various ways to prevent PU but mainly discussed exercising and repositioning as the most effective PUs prevention strategies. However, there is inadequate knowledge about the impact of using pads to reduce pressure ulcers. This was the gap that the study aimed to address. In addition, the study suggests the types of pads used also influence the possibility of developing pressure ulcers. The purpose of the study was to determine the efficiency of a new gel pal for ICU patients. The question the study aimed at answering was: Is a gel pad more efficient in preventing pressure ulcers (PUs) compared to a dermal pad. The question is relevant to the PICOT question which aims at determining the effect of using pads for preventing pressure ulcers within a four-week timeframe.

Method of the study

The author incorporated a cross-sectional method. This was to be able to answer the research question by getting a cross section of patients in the ICU to come up with a representative sample. The author simply recorded the health outcomes of the study participants. The author also incorporated both qualitative and quantitative studies which were relevant to the study. Again, the author used recent journal articles which were less than five years old and others that were a bit older. The literature review clearly indicated the purpose of the study.

Results of the study

Pressure ulcers incidents did not decrease compared to the previous three months. However, out of the 37 patients involved in the study, four of the patients had blanching erythema. None of the four patients who accounted for 11% of the study participants developed category 1 pressure ulcers. Again, the gel pads did not tear unlike the dermal pads. This indicates that a single gel pad can be used for a longer period without tearing or splitting therefore enhancing protection against pressure ulcers.

Ethical considerations

The review board at the Mark Allen Group approved the study. The research was conducted ethically and was aimed at minimizing risk and optimizing benefit for patients. The confidentiality of the patients was protected and their personal information was not disclosed to any third party. There were no ethical considerations related to the study.

Proposed Evidence-Based Practice Change

This study recommends that pads specifically gel pads should be used to prevent pressure ulcers in health centers. The strategy is advantageous for both the nurses and patients. Firstly, the risk of acquiring pressure ulcers for patients is reduced and nurses do not have to constantly change the dermal pads because of tearing. According to Swan, J. (2018), using gel pads is beneficial to all bedridden patients and patients who have worn medical equipment. This is because with the pads, a patient who is not willing to exercise is still protected against pressure ulcers. The study conducted by Swan, (2018) evaluated other prevention strategies such as repositioning, exercising and healthy nutrition and came to a conclusion that using pads is the most efficient strategy. However, he indicates that using pads does not mean patients should not have exercise or be repositioned. Combining the strategies increases the possibility that a patient will not develop pressure ulcers.

The link between PICOT statement, Research Articles and The Nursing Practice Problem.

The problem addressed by the study is inability to entirely eliminate HAPI. The problem is related to the PICOT question which asks whether using pads is an effective strategy to reduce HAPI. Based on the PICOT question, the study is aimed at determining whether the use of pads can effectively reduce cases of pressure ulcers. The PICOT question is trying to find a solution for the nursing practice problem.


Based on the study, it is evident that using pads especially gel pads is an effective way of preventing patients against pressure ulcers. Pads address the needs of patients who are critically ill for instance those in ICU who cannot be repositioned. Pads address the needs of all patients therefore adopting the strategy is an effective way to prevent PU s.

There various ways that can be used to reduce and eliminate HAPI in a health care facility. Some of the ways include repositioning, exercising, using pads and improving nutrition. Considering factors such as some patients may not be able to move while others may not be willing to exercise, using pads is the most effective strategy to reduce and eliminate HAPI. Using pads is not enough, it is important to use the correct pads. Gel pads are more effective than dermal pads. This is because dermal pads easily tear while gel pads do not.


Engels, D., Austin, M., McNichol, L., Fencl, J., Gupta, S., & Kazi, H. (2016). Pressure ulcers: factors contributing to their development in the OR. AORN journal103(3), 271-281.

Swan, J. (2018). Use of dermal gel pads in preventing and managing pressure ulcers in ICU: an audit. British Journal of Nursing27(20), S42-S47.

Frain, R. (2018). Decreasing the incidence of heel pressure ulcers in long-term care by increasing awareness: results of a 1-year program.

Padula, W. V. (2017). Effectiveness and value of prophylactic 5-layer foam sacral dressings to prevent hospital-acquired pressure injuries in acute care hospitals: an observational cohort study. Journal of Wound, Ostomy, and Continence Nursing44(5), 413.