Document Type

DNP Project


School of Nursing

Date of Degree



Doctor of Nursing Practice (DNP)

Primary Advisor

Dr. Mercedes Echevarria; Dr. Elzbieta Kmiecik


Hospital-Acquired Pressure Ulcers (HAPUs); Intensive Care Unit (ICU)


Background: Hospitals had been confronting greater incentives to prevent Hospital-Acquired Pressure Ulcers (HAPUs). HAPU rates had increased in the Intensive Care Unit (ICU) at an academic hospital over the past six months, especially regarding device related HAPUs.

Objectives: The primary purpose of this project’s implementation was to decrease the number of HAPUs in the ICU by 50% within a three-month timeframe. Secondary objectives were to achieve scores of 100% in terms of compliance with the Registered Nurse (RN) education module, post-test scores, and documentation.

Methods: This was a Quality Improvement (QI) project involving adult patients in the ICU of an academic hospital. A five-step model for HAPU prevention called SSKIN was implemented and expanded to SSKIN’D to include devices. This involved 1-month of pre-intervention data collection, implementation of the SSKIN’D educational intervention, and 1-month of post-intervention data collection via documentation audits.

Results: There were more HAPUs in the post-intervention period relative to the pre-intervention period (13 vs. 12). The number of HAPUs per 1,000 ICU patient days declined between the pre- and post-intervention periods, from 12.6 to 11.2. Only 63.9% of RNs ultimately received the SSKIN’D training.

Conclusions: The analysis showed the incidence of HAPUs was not statistically different before and after the intervention (p = 0.77). Not all RNs having received the SSKIN’D education may have contributed to the limited observed clinical impact of the intervention. Other major limitations to this project included the COVID-19 pandemic, a malware attack, and a lack of consistent staffing.

Open Access


Included in

Nursing Commons



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