Leading the way in reducing Hospital-Acquired Pressure Injuries in Older Adult Patients using a Structured Pressure Injury Prevention Bundle.

Acute care hospitals continue to be a major concern for patient safety in the form of hospital-acquired pressure injuries (HAPIs), especially when patients are older and have limited mobility. Pressure injuries are linked to an increased risk of infection, pain, decreased quality of life, and increased healthcare costs, along with longer hospital stays. Older adults are particularly at risk due to the changes that take place in their skin, impaired circulation, chronic disease, and diminished independence in repositioning. While there is evidence available to prevent pressure injuries, there are still implementation inconsistencies that result in preventable pressure injuries among hospitalized patients (Roderman et al., 2024). Standardized preventive care will play a key role in reducing the incidence of HAPI and improving patient outcomes, and this is where evidence-based practice (EBP) interventions will come in handy. This paper aims to examine the effectiveness of a structured bundle of interventions for the prevention of HAPIs in hospitalized older adults with limited mobility in an 8–12-week period and discuss the implementation of the bundle.

Population demographics and health issues.

The population of interest are older adult (65+ years) hospitalized patients with limited mobility in an Acute Care setting. This population is at greater risk for developing pressure injuries due to physiologic changes that occur with age, such as the thinning of the skin, reduced elasticity, decreased tissue blood flow and decreased healing. Older adults are also more likely to have other chronic diseases, such as diabetes, cardiovascular disorders, and malnutrition, which also contribute to their vulnerability of skin breakdown and delayed wound healing. A major risk factor for the development of pressure injuries is the inability of patients to move around frequently enough to begin to lessen the pressure of vulnerable body parts. Those older people who need support to move around, or who spend extended periods of time lying in bed, are more vulnerable to prolonged pressure, friction, and shear. In addition, other factors (inadequate nutrition, incontinence, cognitive impairment etc) can contribute to the risk of pressure injuries. HAPIs negatively impact patients and healthcare providers, as noted by Peterson et al. (2025). Patients can suffer from pain, infection, emotional problems, reduced quality of life, and longer hospital stays. Higher treatment charges, regulatory fines, and diminished quality scores are also seen in healthcare facilities. Hence, preventing high-risk older adults is a key element in patient safety and quality improvement.

Proposed Evidence-Based Intervention

The intervention suggested is the use of a bundle for the prevention of pressure injuries, including repositioning every 2 hours, and a bundle of standardized skin care. The Braden Scale is an acknowledged tool that assists in recognizing patients who are at a high risk of developing a pressure injury because of their mobility, moisture, nutrition, activity, sensory perception, and friction. When patients are identified as being at a high risk, nurses can take preventive actions when needed. The routine repositioning, every two hours, is an evidence-based intervention that is widely agreed upon and will reduce prolonged pressure on vulnerable areas of the body and promote tissue perfusion. Standardized skin care procedures are also very important in prevention of skin care and will help to maintain the integrity of the skin, avoid damage to the skin caused by moisture loss and aid in early detection of changes in skin. Therefore, the intervention seeks to advance health equity by providing everyone who is at high risk for older adults with routine and uniform preventive care regardless of their socioeconomic status, cultural background or disability status. The intervention addresses the national patient safety goals and national Healthy People 2030 Health Care Quality, Minimizing Preventable Complications, and Improving Health Equity for Patients goals. Standardized prevention protocols also reduce inequalities in care due to variation in nursing practice and/or organizational problems. Research shows that structured pressure injury prevention bundles are very effective. Similarly, Demir & Karadag (2025) found that hospitalized adults with the use of evidence-based practice (including repositioning schedules, skin care, risk assessment, and others) experienced a substantial reduction in pressure injuries. Seamless implementation of prevention bundles in everyday nursing practice helps to increase compliance with preventive care and better outcomes for patients.

Comparing with past practice or research.

This is because the traditional approaches to pressure injury prevention are not always consistent across healthcare environments but rather rely on each nurse’s personal interpretation of best practice. Some risk assessments may not be carried out on a regular basis, repositioning schedules may not be carried out due to staffing restrictions, and some skin care interventions may differ between individuals. These disparities add to gaps in care and raise the risk of avoidable pressure injuries. The proposed intervention is also significantly different from standard care because it introduces a prevention package that is structured and coordinated, providing evidence-based practices in a standardized manner throughout the health care team. Standardized interventions provide accountability, consistency, and communication between healthcare providers. Structured prevention bundles have been shown to be more effective than traditional methods to decrease the incidence of pressure injury. Recent studies also confirm that organized prevention programs are more effective than sporadic, routine treatment. Having organized protocols, education for staff, and integrating the flow of work greatly aids in adherence to pressure injury practices. Measurable reductions in the development of pressure injury did occur in high-risk patients who received preventive interventions in the acute care setting.

Expected Outcomes

The anticipated impact of the proposed intervention will be a decrease in Hospital-Acquired Pressure Injuries (HAPI) in older adult patients who have limited mobility. Implementation of the prevention bundle is expected to lead to increased patient safety, maintenance of skin integrity, lower complications, and better overall quality of care. Other likely outcomes include increased evidence-based nursing use of pressure injury prevention strategies, early identification of patients at risk for pressure injury, shorter hospital stays, and lower healthcare costs for treating pressure injuries. The outcome measure will be the number of hospital-acquired pressure ulcers per 1,000 patient-days in the 8–12-week period of implementation. Data collection can also involve compliance audits, patient evaluations, and incident reporting, all of which will help determine the effectiveness of interventions.

The timeframe for implementation and evaluation is given.

The planned intervention will be done and assessed within 8-12 weeks. Nursery staff will be provided with training and education as part of the initial phase, covering the implementation of the prevention bundle, such as the Braden Scale, repositioning, and skin care protocols. Staff will be prepared for implementation through educational sessions and competency assessments. After training, the prevention bundle will be integrated into the daily care of patients. Nurses will perform routine risk assessments, record nursing movement plans, and ensure that skin care plans are adhered to for suitable patients. To assess staff adherence to the intervention and patient responses to the intervention, continuous monitoring and data collection will be provided throughout the intervention period. During the implementation period, pressure injury incidence rates will be compared to baseline data to evaluate the effectiveness of interventions at the end of the implementation period. The results of this evaluation can also help identify areas that need to be improved in terms of quality and sustainability in the long term (Tomas & Mandume, 2024).

Use of Nursing Science and Population Health Concepts

Nursing Science

Nursing science has a significant contribution to make in helping to guide evidence-based pressure injury prevention care practices. To identify at-risk patients and to take timely preventive measures, nursing knowledge, nursing clinical judgment and a focus on the patient must be applied. Evidence-based nursing practice incorporates the latest research evidence and clinical skills to enhance the quality of patient care and health care. Nurses are at the very center of pressure injury prevention through conducting pressure injury risk assessments, skin integrity monitoring, patient and family education, and interdisciplinary care coordination.

Social Determinants of Health

SDOH are important contributors to the development of pressure injuries and outcomes of care for patients with pressure injury. Patient health status and recovery may be impacted by income, access to healthcare, nutrition, education, and social support. As an individual ages, his/her finances and care capacity might decrease, and this may result in inadequate nutrition or access to health care services or worsening of chronic conditions affecting the skin. Social determinants must be addressed in culturally competent and equitable ways to deliver better outcomes for those at risk by using patient-centered care.

Epidemiologic Data

Occurrence of pressure wounds has been reported in large numbers among older age in hospital settings from episodic data and public health data. Aging, immobility, chronic illness, and prolonged length of stay are high-risk factors for development of a pressure injury. The prevention of pressure injuries is supported by epidemiologic evidence, given that pressure injuries contribute to increased morbidity, mortality, healthcare costs, and hospital readmissions. Pressure injury incidence rates can be used to evaluate the success of pressure injury prevention strategies to improve patients’ safety outcomes in the healthcare setting.

Genomic and Genetic Data

Genetic and genomic factors may also influence pressure injury risk and healing capacity. Some people may have inherited characteristics that influence skin integrity, inflammatory reactions, blood flow, and tissue healing. Genetic predisposition to chronic conditions such as diabetes and vascular disease could further make an individual susceptible to PI and delayed wound healing. While genetic factors can be a predisposing factor for pressure injuries, the understanding of individual patient risk profiles can be used to help inform personalized approaches to prevention and treatment (Hajj et al., 2024).

Conclusion

Pressure injuries are a preventable adverse event that can have a substantial negative impact on older adults who are admitted to an acute care hospital and have limited mobility. A bundle of care, which includes Braden Scale pressure injury risk assessment, routine repositioning, and a pressure injury skin care bundle, is an evidence-based approach that can help reduce the incidence of pressure injuries and enhance outcomes. The intervention proposed will help to improve healthcare equity, patient safety and nursing practice uniformity. Nursing science, social determinants of health, epidemiology and genetics all highlight the importance of comprehensive prevention for vulnerable patient populations. Healthcare providers can use evidence-based interventions and routine care practices to keep patients safe, reduce complications and provide quality health care to older patients who are admitted to hospitals.
References

Demir, A. S., & Karadag, A. (2025). Impact of Care Bundles Prevention of Hospital‐Acquired Pressure Injuries: A Systematic Review and Meta‐Analysis. Nursing Open, 12(3). https://doi.org/10.1002/nop2.70173

Hajj, J., Sizemore, B., & Singh, K. (2024). Impact of Epigenetics, Diet, and Nutrition-Related Pathologies on Wound Healing. International Journal of Molecular Sciences, 25(19), 10474. https://doi.org/10.3390/ijms251910474

Peterson, A., Fraix, M. P., & Agrawal, D. K. (2025). Preventing pressure injuries in individuals with impaired mobility: Best practices and future directions. Journal of Surgery and Research, 8(3). https://doi.org/10.26502/jsr.10020455

Roderman, N., Wilcox, S., & Beal, A. (2024). Effectively Addressing Hospital-Acquired Pressure Injuries With a Multidisciplinary Approach. HCA Healthcare Journal of Medicine, 5(5). https://doi.org/10.36518/2689-0216.1922

Tomas, N., & Mandume, A. M. (2024). Nurses’ barriers to the pressure ulcer risk assessment scales implementation: A phenomenological study. Nursing Open, 11(1). https://doi.org/10.1002/nop2.2079

Appendix A – PICOT Question

PICOT Question:

Does implementing a structured pressure injury prevention (PIP) bundle reduce the incidence of hospital-acquired pressure injuries (HAPI) in older adult hospitalized patients aged ≥65 years who have limited mobility in acute care compared to standard care over 8–12 weeks?

The APA Writing Checklist can be found in Appendix B.

APA Writing Checklist

APA Formatting

Title page included
Running head (if necessary)
Proper font and spacing used
One-inch margins applied
Page numbers included
APA headings are properly formatted.

Scholarly Writing

Clear introduction provided
Thesis/purpose statement included
Logical organization of ideas
An academic tone is preserved throughout the text.
Correct use of grammar, spelling, and punctuation used
3rd person academic style was used.
Citations and References
In-text citations with necessary.
APA 7th edition references are formatted.
All the references can be found in the text.
Peer-reviewed scholarly sources used
Written sources from the past 5 years.

Assignment Requirements

Population demographics discussed
Health concerns identified
Evidence-based intervention explained
Similar to other practices:
Expected outcomes discussed
Timeline for implementation explained
Nursing science applied
Social factors and determinants of health that may be addressed
Epidemiologic data included
Genomic/genetic aspects considered
This question is attached in the Appendix as a PICOT question.

Final Review

If you are reviewing a paper for APA, you should: When reviewing a paper for APA, you should:
LopesWrite submission completed
Assignments and other work in a rubric reviewed prior to submission

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Assessment Description
Refer to the PICOT you developed for your evidence-based practice project proposal in the Evidence-Based Practice Project Proposal: PICOT assignment in Topic 3. If your PICOT required revision, include those revisions in this assignment. You will use your PICOT paper for all subsequent assignments you develop as part of your evidence-based practice project proposal in this course and in NUR-590, during which you will synthesize all of the sections into a final written paper detailing your evidence-based practice project proposal.

Write a 750-1,000-word paper that describes your PICOT. Include the following:

Describe the population’s demographics and health concerns.
Describe the proposed evidence-based intervention and explain how your proposed intervention incorporates health policies and goals that support health care equity for the population of focus.
Compare your intervention to previous practice or research.
Explain what the expected outcome is for the intervention.
Describe the time for implementing the intervention and evaluating the outcome.
Explain how nursing science, social determinants of health, and epidemiologic, genomic, and genetic data are applied or synthesized to support population health management for the selected population.
Create an appendix for your paper and attach the PICOT. Be sure to review feedback from your previous submission and revise your PICOT accordingly.
Complete the “APA Writing Checklist,” located in Class Resources, to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper.

Refer to “Evidence-Based Practice Project Proposal – Assignment Overview,” located in Class Resources, for an overview of the evidence-based practice project proposal assignments.

You are required to cite four to six peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MBA-MSN; MSN

4.1: Synthesize nursing science, determinants of health, and epidemiologic, genomic, and genetic data in the management of population health.

PICOT Final

Name_____________________________________

Complete your PICOT using your approved proposed nursing practice problem. If they were approved, you may use the population and intervention developed in your Topic 1 assignment. Include any necessary revisions in this submission. Refer to the “Example PICOT” below as needed for guidance on how to complete the PICOT.

PICOT Question
P	Population	Hospitalized older adult patients (aged 65 years and above) with limited mobility in acute care settings
I	Intervention	Implementation of a structured pressure injury prevention bundle (Braden Scale risk assessment, repositioning every two hours, standardized skin care protocol)
C	Comparison	Standard care without a consistently implemented structured prevention bundle
O	Outcome	Reduction in the incidence of hospital-acquired pressure injuries (measured as new cases per 1,000 patient-days)
T	Timeframe	8–12 weeks
PICOT Create a complete PICOT statement.	In hospitalized older adult patients aged 65 years and above with limited mobility in acute care settings, how does the implementation of a structured pressure injury prevention bundle compared to standard care affect the incidence of hospital-acquired pressure injuries over 8–12 weeks?
Problem Statement Create a problem statement for your PICOT. You will use this problem statement throughout your final written paper.	Hospital-acquired pressure injuries (HAPIs) are a serious and avoidable complication in the acute care facility among older adult patients with low mobility. This group in the population is specifically susceptible to age-related skin alterations, diminished tissue tolerance, and loss of the ability to reposition independently. It has been proven that the rates of pressure injuries can be significantly decreased in acute care settings through structured prevention methods, such as regular repositioning, the use of validated risk assessment tools, and standardized skin care protocols (Lovegrove et al., 2021). Nevertheless, even with the presence of these evidence-based interventions, lapses in the regular practice remain among the factors that lead to poor patient outcomes. Barriers at the organizational and system levels also make implementing pressure injury prevention strategies more difficult. Staffing differences, workflow inefficiency, and the absence of standardized procedures have been cited as the primary contributors to variations in compliance with prevention practices in healthcare settings (McMahon et al., 2025). The research dedicated to the implementation also suggests that the incorporation of structured prevention bundles into the daily clinical routines increases adherence and patient outcomes due to the better coordinated care provision (Edsberg et al., 2022). Also, clinical experience demonstrates that programmed preventive measures in high-risk groups, including immobile intensive care unit patients, lead to quantifiable changes in the incidence of pressure injuries (Martin-Meana et al., 2025). The practice gaps identified above need to be tackled as a structured and consistently put into practice prevention bundle to enhance patient safety, complications, and nursing care quality.

References

Edsberg, L. E., Cox, J., Koloms, K., & VanGilder-Freese, C. A. (2022). Implementation of pressure injury prevention strategies in acute care. Journal of Wound Ostomy and Continence Nursing, 49(3), 211–219. https://doi.org/10.1097/won.0000000000000878

Lovegrove, J., Fulbrook, P., Miles, S. J., & Steele, M. (2021). Effectiveness of interventions to prevent pressure injury in adults admitted to acute hospital settings: A systematic review and meta-analysis of randomized controlled trials. International Journal of Nursing Studies, 122, 104027. https://doi.org/10.1016/j.ijnurstu.2021.104027

Martín-Meana, C., González-Darias, J. M., Chinea-Rodríguez, C. D., Del Cristo Robayna-Delgado, M., Del Carmen Arroyo-López, M., Arias-Rodríguez, Á., Jiménez-Sosa, A., & Fariña-Martín, P. (2025). Effectiveness of additional preventive measures for pressure injury prevention in an intensive care unit: a retrospective cohort study. Nursing Reports, 15(7), 259. https://doi.org/10.3390/nursrep15070259

McMahon, J., McInnes, E., Wan, C. S., Straiton, N., Lam, L., Rodgers, J., Dickson, J., & Fulbrook, P. (2025). Effectiveness of organizational strategies for pressure injury prevention and treatment in acute hospital settings: a Systematic review. Journal of Advanced Nursing, 82(3), 2004–2021. https://doi.org/10.1111/jan.17090