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A quality improvement programme to reduce hospital-acquired pressure injuries
  1. Poonam Gupta1,
  2. Shiny Shiju2,
  3. Gracy Chacko2,
  4. Mincy Thomas2,
  5. Asma Abas2,
  6. Indirani Savarimuthu2,
  7. Emad Omari2,
  8. Sara Al-Balushi3,
  9. Pulikana Jessymol2,
  10. Sunitha Mathew4,
  11. Marife Quinto4,
  12. Ian McDonald2,
  13. William Andrews1
  1. 1Quality and Patient Safety, Hamad Medical Corporation, Doha, Qatar
  2. 2Nursing Department, Hamad medical Corporation, Doha, Qatar
  3. 3Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
  4. 4Wound Care Department, Hamad Medical Corporation, Doha, Qatar
  1. Correspondence to Dr Poonam Gupta; dubai.poonam{at}


Background At Heart Hospital in Doha, Qatar (HH), 127 pressure injuries (PI) were identified in 2014, corresponding to an incidence of 6.1/1000 patient-days in first 4 months of 2014. Hospital-acquired pressure injury (HAPI) is one of the most common preventable complications of hospitalisation. HAPI significantly increases healthcare costs, including use of resources (dressings, support surfaces, nursing care time and medications). They also have a significant impact on patients in terms of pain, worsened quality of life, psychological trauma and increased length of stay. Working with the Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in all In patient Units at HH with the aim of reducing the number of HAPIs by 60% within 2 years.

Methods In collaboration with IHI, our multidisciplinary clinical and risk assessment teams tested several changes and implemented a successful programme. The Surface, Skin inspection, Keep moving, Incontinence and Nutrition bundle was implemented. Signs, turning clocks and PI incidence ‘calendars’ were used in the units as reminders. Attention was paid to endotracheal tube ties in order to address device-related pressure injuries. Counts of HAPI (incidence) and number of PIs per 100 patients surveyed (prevalence) were prominently displayed. Changes were tested using the Plan-Do-Study-Act methodology. Statistical analysis using the independent t-test was applied to detect the significance of any difference in the incidence of HAPI before and after implementation of the changes.

Results The incidence of HAPI dropped from 6.1/1000 patient-days to 1.1/1000 patient-days, an 83.5% reduction. The prevalence, based on quarterly survey fell from 9.7/100 patients surveyed to 2.0/100 patients surveyed, a 73.4% decline.

Conclusions The interventions proved to be successful, reducing the incidence of PI by >80%. The outcomes were sustained over a 4-year period.

  • pressure injury
  • prevention
  • quality improvement
  • incidence
  • prevalence

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  • Contributors PG designed and led the study and prepared initial draft of this manuscript. SS, MT, GC, IS and AA contributed by testing and implementing change ideas and data collection. SM and MQ assisted in prevalence surveys and providing valuable inputs from wound care point. EO supervised work in high dependency units. IMcD supervised the sustainability of the process. SAB contributed to the analysis and interpretation of the data. WRA played key role in the preparation of the manuscript and providing valuable inputs.

  • Funding There was no external funding for this project. The overall quality improvement effort 'Best Care Always' was entirely funded by the Hamad Medical Corporation, our parent organisation.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, conduct, reporting or dissemination plans of this research. Refer to the 'Methods' section for further details.

  • Patient consent for publication Not required.

  • Ethics approval An institutional review board was not sought to review as all of the changes being tested were evidence based and widely accepted internationally. There was no control group and therefore no randomisation, so no patients would be denied this ‘best practice’ intervention.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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