IHA case studies

Beyond HAPU Prevention: Differentiating Between Moisture-Associated Skin Damage and Pressure Ulcers


The medical center consistently missed internal quality targets, with a mean HAPU rate for 2007-2013 of 5.39 percent, median 5.33 percent. Although HAPU prevention measures had been put in place previously with some improvement, results were not significant or sustained. An analysis of current practices, processes and outcomes was conducted by the certified wound care nurse. A high rate of MASD was identified, which significantly increases a patient's risk for pressure ulcer development. Other key gaps identified included: no new hire training on HAPU/MASD prevention; staff RNs unaware of recent changes to pressure ulcer definition; diaper use for incontinence care; clinical challenges in the differential diagnosis of MASD versus PUs; and a lack of individualized prevention plans based on Braden subscale score. A HAPU prevention bundle was designed to address key gaps including a focus on differential assessment of MASD vs PUs. Formal didactic and clinical training of the skin care team RNs who conduct prevalence surveys was critical. The CWCN also began assessing and validating all potential HAPUs and MASD. These efforts resulted in a 70 percent reduction in HAPU over six months.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state.  These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

  • Safe
  • Timely
  • Effective
  • Efficient
  • Equitable
  • Patient-centered

(The Institute of Medicine's six aims for improvement.)

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