Date of Graduation

Fall 12-17-2021

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Executive Leader DNP

First Advisor

Juli Maxworthy

Second Advisor

Alexis Curtis


Background: Hospital-acquired pressure injuries (HAPIs) are rising in the United States, increasing six percent between 2014 and 2017 alone (Agency for Healthcare Research and Quality [AHRQ], 2019). Approximately 60,000 patients die from complications related to HAPI annually (Padula & Delarmente, 2019).

Local Problem: In a Northern California Level II Trauma acute care hospital, HAPIs increased by 422% over two years, 2016-2018, with most of the HAPIs occurring in the Intensive Care Unit (ICU).

Context: This project sought to spread the Interventions by Braden Subscale protocol to seven medical-surgical units in the hospital using the Institute for Healthcare Improvement’s (IHI) Framework for Spread and Lewin’s Change Management Theory.

Interventions: A baseline survey was disseminated to ascertain the level of knowledge on the IHI Framework for Spread, and education was subsequently developed based on the results. The Interventions by Braden Subscale protocol was spread utilizing the framework to multiple medical-surgical units with the goal of reducing HAPIs.

Outcome Measures: Improve the level of knowledge among nurse leaders by 30% on the IHI Framework for Spread and reduce HAPIs in the medical-surgical units by 30%.

Results: The successful spread led to a net reduction of 34% in the incidence of all-stage HAPIs. No improvement was seen in the level of knowledge among nursing leaders on the IHI Framework for Spread. Results were analyzed from the pre-and post-education surveys and were found to not be statistically significant and may have been impacted by the SARS-COV-2 pandemic.

Conclusions: Using a structured framework to spread improvement work demonstrated benefit in this project and became the platform for the development of a committee where improvement work could be reported in a standardized way, monitored for performance, spread, and sustained over time.

Included in

Nursing Commons