Title : HAPITZ as HABIT
Patients enter into the hospital with trust of being not harmed. Florence Nightingale emphasized on “We should do sick No harm”. Hospital acquired pressure Injury (HAPI) should be considered as “Never Nursing Incident”. Developing HAPI is not due to the disease but reflects Poor Nursing (Florence Nightingale). Pressure ulcers cause considerable harm to patients, hindering functional recovery, with an extended length of stay, sepsis, and mortality. The role of Whistleblower was initiated immediately in a view of partnering for prevention when high prevalence of HAPI was noted (45 pressure ulcer in a year) in one of the tertiary care hospital. The safety initiatives were defined and adopted immediately to reduce the HAPI incidence to Zero (HAPITZ).Thus, we strived to find multidisciplinary modalities to reach at HAPITZ and continue as HABIT. We named our journey “HAPITZ as HABIT”
Well-defined policy, innovative preventive strategies and various toolkits are the bases of 365-degree approach to achieve HAPITZ. Turning clock is an innovative cost-effective tool, which was designed by using regular clock, and it is placed in every Nursing station. It ensures uniformity in positioning across the unit (as defined in the clock) and serves as visual reminder tool. The daily calendar was designed and encouraged the in-charges to adopt self-reward mechanism by coloring as Green on daily basis if there is no HAPI. Monthly performance Scorecard linked to appraisal for in-charge is put into practice where HAPITZ is considered as an important measurable outcome. PU Vs IAD differentiation pocket cards were given to all staffs for quick reference. CUSP initiated to ensure better compliance and outcome through the involvement of multidisciplinary members. Innovative training strategies adopted as Room of horror, Skill-a-thon, what is wrong in it, Learning while doing made the HAPITZ awareness as a successful one. Patient and relatives of moderate to high Braden score are involved in shared decision making for HAPITZ preventive strategies.
The results of “HAPITZ as HABIT” journey revealed significant improvements in Hospital acquired pressure injury through implementing 365-degree approach. The retrospective data analysis of 14 months showed - 4 HAPI every month and 1 Pressure ulcer per 1266 inpatient days. Through Comprehensive Unit Safety programme (CUSP), the planned strategies were implemented in the month of March 2019. The immediate effect of implementation could not be appreciated as HAPI incidence went up to five. With extensive awareness campaign and CUS method, the incidence of HAPI in month of April 2019 reduced to three. The incidence of HAPI for the consecutive five months from May till Sept 2019 has been ZERO and zero HAPI per 4897 inpatient days. The effectiveness of 365-degree approach was evident as there is 100% improvement in outcome. CUSP committee was involved in validating the data on regular basis to eliminate under-reporting. There was significant improvement in the Patient satisfaction and nursing staff satisfaction was noted.