Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2020


Doctor of Nursing Practice (DNP)

Primary Advisor

Mercedes Echevarria, DNP, APN; Elzbieta Kmiecik, DNP-EL, RN, CCRN-K, CJCP


Background: More than 2.5 million people develop pressure ulcers (PUs) annually. PUs cost the U.S. $9.1-11.6 billion per year and add about $43,180 to a hospital stay. The Centers for Medicare Medicaid Services (CMS) stopped reimbursement for hospital-acquired pressure ulcers (HAPUs). Documentation of PUs must indicate if they are present on admission (POA) and include accurate stages and treatment plan of PUs. Aims/Objectives: To use Digital Imaging platform using Tissue Analytics (TA) along with the standard care protocol. The objectives of this study were to (1) Improve identification of PUs, (2) Increase accuracy of PU staging and (3) Improve documentation of PUs.

Methods: This quality improvement study included a convenience sample of 55 adults with HAPUs. NDNQI measures and data from chart audits were collected. Demographic information, POAs and HAPUs, and Braden scores were analyzed along with a staff attitude’s survey.

Results: 5.11 POAs per 1000 patient admissions (95% CI = [3.33, 7.84]) pre-interventions, and 2.25 POAs per 1000 patient admissions (95% CI = [1.17, 4.33]) post-intervention. POA prevalence rate remained about the same. Documentation of HAPU stages (χ2 (5) = 9.823, p = 0.059) was not statistically significant but documentation of POA staging was significant (χ2 (6) = 16.395, p = 0.003). The number of DTIs increased while Unstageable PUs decreased post-intervention. Braden score= 14.52 (SD = 3.65) pre-intervention and 14.56 (SD = 2.55) post-intervention. Staff Attitudes’ survey scores reflected poor PU prevention attitude (33.36).

Conclusions: Digital imaging Platform using TA along with the standard protocol did not significantly improve the identification of POAs nor rate of documentation. Documented difference in staging was noted. Also, improved quality of documentation was noticed.

Open Access


Included in

Nursing Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.