Date of Graduation

Spring 5-24-2018

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Elena Capella



The aim of the project is to improve the process and delivery of care with established and accepted standards by implementing evidence-based change. The plan is to create a HAPI prevention plan with the main expected outcome to reduce the HAPI occurrences on the unit to zero by July 30, 2018. This will be accomplished by increasing awareness among nursing staff members through education and diligent monitoring of prevention practices and treatments.

The education portion of the plan will include reviewing basic pressure injury education and HAPI prevention and management in the form of visual aids provided by the WOCN and a standard operating procedure, also known as a standard work, that will be used as a guide to HAPI prevention on the unit. A self-evaluation tool will also be used to allow nursing staff to rate their understanding prior to and after in-services of the information are provided. The monitoring portion of the plan includes the creation of monitoring tools to properly track compliance of the interventions, such as a Turning Wheel to monitor repositioning and chart reviews to monitor documentation and use of skin care prevention products. The expected objectives include (1) increased awareness of the importance of HAPI prevention, (2) a clear understanding of HAPI prevention methods, and (3) increased confidence in HAPI education and management.

The organization serves 9 million enrolled Veterans and their families every year. While mental health is a strong area of focus where suicide, homelessness, and trauma exceed the national rate of the general population, this patient population that consists of primarily men ages 60+ also suffer from multiple co-morbidities, such as congestive heart failure, diabetes, pulmonary issues, and cancer. Therefore, this population is at risk for developing health issues that can have a significant impact on patients’ lives and hinder the ability of the healthcare clinician to provide high quality care (JCAHO, 2016).

Positive outcomes include an 80% completion rate of the turning wheels and documentation as well. There has been a noticeable increase in the use of skincare prevention products. Also, the HAPI occurrence rate has been at zero since the implementation of the project, which is due to increased staff awareness and support and collaboration between the WOCN, unit skin champions, and management. Concurrently, it has been reported by multiple staff members that team morale is increased as goals are being achieved due to the strong teamwork that this project has created for staff to prevent HAPI occurrences on the unit. There was an 80% completion rate of the turning wheels and documentation as well.


Joint Commission (2016). Preventing pressure injuries. Retrieved from

US Department of Veterans Affairs (2018). Veteran Population. Retrieved from