A Conversation with WCA CNO Christina Le, MSHA, BSN, RN, WCC, CWS, OMS
As Covid-19 patients overwhelmed hospitals and staff shortages hit, Hospital-Acquired Pressure Injuries (HAPI) rates skyrocketed. Hospital systems are still fighting to get these numbers back to pre-Covid levels. In this blog, we’re talking with WCA CNO Christina Le about what hospitals can do to lower their HAPI incidences and the vital role in this process.
During COVID-19, hospitals reported an increase in HAPI incidents. What do you think contributed to that? Are there safeguards and methods that were pulled back that need to be reinstated?
The two biggest contributions as to why HAPI incidents increased over the last two years were due to the way we had to position patients with COVID-19 (in the prone position) or with medical device such as tubing.
The second was a result of the increased workload due to COVID-19. With surges occurring and being short staffed, bedside nurses had to prioritize the complexity of the patient's illness to ensure a high level of care delivery was met and to prevent further spread of the virus
Now that our COVID-19 numbers have decreased again, it’s time to re-evaluate prevention and education among our high risk patients. With new staff in the hospitals as well, we need to ensure everyone feels comfortable identifying wound cares and proper treatments.
What challenges did hospitals face in treating HAPIs during COVID-19?
The biggest challenge was coming in contact with unavoidable pressure injuries. Due to the severity of the virus, the treatment itself became a major factor in the development of HAPIs.
Patient proning was one of them. Proning is when we place the patient on their stomach during respiratory distress. Due to this position, it becomes very difficult to offload areas such as cheeks, ears, chin, shoulders, or knees, despite best efforts.
What can wound care departments do for their hospital system to help prevent HAPIs?
We know what to expect with another COVID-19 surge. Make sure your team understands all the preventative measures your hospital system has and how to use them. Encourage your wound care team to step up and provide as much support as possible, such as developing accountability groups, reduction goals, and standardize protocols. And make sure not all reduction goals fall on one department but share the responsibility of prevention across the hospital.
What dangers and additional costs do HAPIs pose to patients and hospitals?
HAPIs can be very dangerous for patients because they can cause more issues such as pain, infection, or even death. Depending on the severity of their HAPI, it can also lead to a longer hospital stay. For hospitals, the cost of a HAPI can be very costly.
The CMS has reduced reimbursement related to hospital-acquired conditions, including HAPIs. So the full financial burden is falling to the hospital and can range from anywhere from $500 to $70,000 for a single episode. Not to mention, the time and clinical resources it will take the hospital to treat the HAPIs.
What barriers do hospitals face in getting HAPI levels back to pre-Covid levels?
The biggest barrier in getting your hospital back on track with HAPIs will be getting your team back onboard after the COVID-19 burn out. With cases of the virus slowing down, we have an opportunity to make sure all our processes in preventing HAPIs are back in place. But only if you can get your teams re-engaged. Focus on encouragement and bring a plan back to the team to show that they can attack this challenge together. Don’t pin it in only one department, reinforce that this will be a group effort.
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