Hospital-Acquired Pressure Ulcers


The soaring of healthcare expenditures and the constant demand for improved patient outcomes create a strong need for cost-effective yet high-quality care. That is why the examination of ways how to enhance patient care is usually regarded as a top priority of researchers in the field of healthcare. The given paper focuses on hospital-acquired pressure ulcers (HAPUs) that are associated with patient suffering and high costs of care and thus represent a serious subject of concern at both national and local levels.

Purpose Statement

Only if a compelling practice problem has been thoroughly articulated can ways of dealing with it be reasonably considered. The purpose of the given research paper is to identify a practice problem of HAPUs and evaluate its significance, relevance, and economic ramifications at the national and local levels. It is also important to determine the role of the DNP practice scholar in tackling the practice problem.

Practice Problem Identification

HAPUs are considered to be one of the major clinical issues that can lead to increased length of stay, infection, and patient suffering. Factors associated with the incidence of HAPUs include pressure, immobility, age, and prolonged duration of mechanical ventilation. Though being accepted nursing quality indicators, HAPUs that have reached stages 3 and 4 signify serious tissue damage extending into the muscle, tendon, or even bone (Rondinelli et al., 2018). Given the serious clinical complications of HAPUs and the tremendous burden they place on the healthcare system, pressure ulcer prevention care needs to be improved.

Role of the DNP Practice Scholar in Influencing Practice Problems

DNP scholars have the required skills and knowledge to act as leaders in complex healthcare systems. Nurse practitioners prepared at the DNP level can guide improvements in the quality of care and healthcare systems. Through tasks delegation, utilization of effective communication strategies, and great comprehension of the healthcare environment, a DNP practice scholar is prepared to make a significant contribution to finding and implementing a solution to a practice problem.

Implications of the Practice Problem at the National Level

Pressure ulcers (PUs) occur in various care settings in patients of different ages. Implications of pressure ulcers at the national level are severe as insidious complications of HAPUs affect 2.5 million patients annually (Pickham et al., 2016, p. 190). The incidence rate of HAPUs stands at 31% per thousand discharges (Rondinelli et al., 2018, p. 17). The proportion of healthcare costs associated with prevention and treatment of PUs is thus great.


People diagnosed with pressure ulcers feel pain brought by skin lesions and experience a high risk of serious infection which may lead to severe consequences. Prevention of HAPUs is a great challenge faced by acute care hospitals in the US (Ranzani, Simpson, Japiassú, & Noritomi, 2016). Successful implementation of nursing practices to prevent and treat HAPUs is expected to reduce their occurrence and the associated costs and create positive patient outcomes.


Health care organizations only begin to elaborate new assessment techniques, which is why a decrease in the incidence rate of HAPUs is slight (Rondinelli et al., 2018). For some groups of patients, in particular, critically ill ones, application of standardized scales to identify the risk level of pressure ulcer showed poor performance prediction (Ranzani et al., 2016). Since the payment provided for certain hospital-acquired conditions, including stages 3 and 4 of HAPUs, was ceased, the relevance of the selected practice problem is considerable.

Economic Ramifications

Each year, pressure ulcers account for approximately $11 billion of healthcare expenditures, primarily due to prolonged hospitalization (Pickham et al., 2016, p. 190). In addition to direct treatment costs, PUs result in litigation and government penalties. Given that Centers for Medicare and Medicaid Services allowed for only limited reimbursement for HAPUs, a significant proportion of the financial burden of medical treatment has been put on patients (Pickham et al., 2016, p. 190). Since costs associated with the treatment of HAPUs are high, the demand for early-stage prevention is great.

Impact of the Practice Problem at the National Level on Key Stakeholders

Taking into account the economic ramifications of the practice problem, patients with pressure ulcer as a secondary diagnosis and families of these patients are going to feel the financial burden. Interventions to prevent and treat HAPUs will appear to be extremely laborious for the nursing staff. Interprofessional team members will have to consider changing nursing practice to treat and prevent HAPUs. Members of healthcare organizations will have to consider planning healthcare budgets appropriately and managing the nursing schedule.

Implications of the Practice Problem at the Local Level

At the local level, implications of the practice problem are limited to the scale of a particular healthcare setting, such as the residential care homes and non-profit nursing homes. It can be expected that the incidence of PUs will become a major clinical risk for non-profit nursing homes, the majority of which operate with less than needed workforce (Kwong, Lee, & Yeung, 2016). Local hospitals will have to create protocols and optimal preventative practices to reduce HAPUs.

Significance, Relevance, and Economic Ramifications

The significance of the practice problem for the local setting can be explained by the need of local healthcare establishments to avoid poor patient outcomes associated with the increasing prevalence of the condition. The relevance of practice problem can be well illustrated by a great number of current action research studies testing developed protocols to prevent PUs. The cost of healing pressure ulcers across various healthcare settings is approximately $40,000 for stage 2 PUs and $90,000 for stage 4 PUs (Ocampo et al., 2017, p. 320). Therefore, economic ramifications of PUs reveal that they are costly and prevention is preferable to treating them.

Impact of the Practice Problem at the Local Level on Key Stakeholders

Patients and families are going to face not only expensive care but also its high or low quality depending on whether a particular hospital has made appropriate changes in the nursing practice. Nurses will be assigned additional tasks and may be required to undergo training on PUs prevention. The interprofessional team will be engaged in the creation of a protocol for PUs assessment and prevention. Members of healthcare organizations will have to consider resources which may be needed by local hospitals to lead the change successfully.


At the national level, the practice problem has a tremendous effect on healthcare costs, and the prevalence rate of HAPUs is high. At the local level, many hospitals face the urgent necessity to develop assessment procedures to improve PU prevention care. The DNP practice scholar is expected to be a leader of an interdisciplinary team and a change agent who possess a thorough understanding of communication and team process and has the required skills to lead the change.


Kwong, E. W., Lee, P. H., & Yeung, K. (2016). Study protocol of a cluster randomized controlled trial evaluating the efficacy of a comprehensive pressure ulcer prevention programme for private for-profit nursing homes. BMC Geriatrics, 16(1), 20-26. Web.

Ocampo, W., Cheung, A., Baylis, B., Clayden, N., Conly, J. M., Ghali, W. A.,… Hogan, D. B. (2017). Economic evaluations of strategies to prevent hospital-acquired pressure injuries. Advances in Skin & Wound Care, 30(7), 319-333. Web.

Pickham, D., Ballew, B., Ebong, K., Shinn, J., Lough, M. E., & Mayer, B. (2016). Evaluating optimal patient-turning procedures for reducing hospital-acquired pressure ulcers (LS-HAPU): Study protocol for a randomized controlled trial. Trials, 17(1), 190-197. Web.

Ranzani, O. T., Simpson, E. S., Japiassú, A. M., & Noritomi, D. T. (2016). The challenge of predicting pressure ulcers in critically ill patients: A multicenter cohort study. Annals of the American Thoracic Society, 13(10), 1775-1783. Web.

Rondinelli, J., Zuniga, S., Kipnis, P., Kawar, L. N., Liu, V., & Escobar, G. J. (2018). Hospital-acquired pressure injury: Risk-adjusted comparisons in an integrated healthcare delivery system. Nursing Research, 67(1), 16-25. Web.

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