pressure injury

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Objectives, Strategies and Background Analysis

Objectives, Strategies, and Background Analysis

Pressure injuries remain a preventable safety concern for long-term care patients, especially for those who experience limited mobility. This safety concern remains a challenge despite the availability of clinical guidelines for the prevention of facility-acquired pressure injuries. This condition occurs due to non-adherence to repositioning protocols and documentation guidelines. Research has proven that the use of a turning schedule for the prevention of tissue damage reduces the development of complications (Asiri, 2023). Quality improvement initiatives should be conducted to address system-wide barriers that interfere with evidence-based practice implementation. The PICOT question for the quality improvement project is as follows: In adult long-term care patients who are at high risk for developing a pressure injury in Nightingale Skilled Nursing Facility (P), will the implementation of a scheduled two-hour repositioning protocol (I), compared to current repositioning practices (C), result in a reduction in facility-acquired pressure injuries by 25% (O) in 12 weeks (T)? The purpose of this paper is to outline the project objectives, describe the strategies used to achieve them, and analyze the background factors that support the need for this improvement project.

Objectives

Three objectives were identified for this project proposal, and they are based on the SMART criteria. The first objective is to reduce the occurrence of new facility-acquired pressure injuries among high-risk residents by 25% within a period of 12 weeks by implementing a structured two-hour repositioning schedule for residents. This is specific to high-risk residents, measurable by tracking data, attainable considering research supporting scheduled repositioning, realistic considering the time frame, and time-bound. The research supports routine turning intervals as a primary prevention strategy for adults (Asiri, 2023).

The second objective is to increase nursing staff’s documentation compliance for repositioning to at least 90% within 12 weeks. This is measurable by weekly chart audits, which is a direct measure for evaluating the effectiveness of the intervention. Documenting compliance for pressure injury risk assessments and preventive documentation is related to improved patient outcomes and reduced adverse events (Gassas et al., 2025).

The third objective is to improve staff knowledge and self-efficacy for pressure injury prevention by 20% as measured by pre- and post-education surveys within a 12-week period. This is a specific, measurable, achievable, and time-bound objective. Nurses' confidence and workload perception are related to adherence to preventive measures (Gwag & Kim, 2026).

Strategies

Objective 1: Reduce the number of new facility-acquired pressure injuries by 25% within 12 weeks. The first strategy that will be used to attain the goal of reducing new facility-acquired pressure injuries is the implementation of the standardized two-hour turning protocol with the addition of visual cues. This will be done by placing repositioning clocks and turning schedules at the patient's bedside. Standardized repositioning intervals have been found to minimize variations in the delivery of care (Asiri, 2023). The second strategy that will be used to attain this goal is the selection of a "turning champion" who will be responsible for each shift. Leadership support, as well as role accountabilities, have been found to increase the reliability of preventive practices (Gwag & Kim, 2026). This combination of visual reminders and shift accountability is intended to increase consistency in repositioning and strengthen adherence to the two-hour protocol.

Objective 2: Increase documentation compliance to at least 90% within 12 weeks. The first strategy to achieve this goal is to modify the electronic system of documentation to include simplified repositioning flowsheets or check boxes to minimize the effort of charting. Barriers to documentation sometimes result in incomplete preventive records (Gassas et al., 2025). The second strategy to achieve this goal is to perform weekly audits of charts and provide immediate feedback to the staff. Audit and feedback processes strengthen practice standards and increase compliance rates. Improving documentation efficiency and pairing it with consistent feedback is expected to support higher accuracy and accountability in charting.

Objective 3: To improve the knowledge and self-efficacy of the staff by 20% within the next 12 weeks. The first strategy is to provide mandatory in-service education focused on early skin assessment, turning techniques, and identifying residents who are at risk. Research shows that educational interventions strengthen adherence to preventive behaviors (Gwag & Kim, 2026). The second strategy is to provide quick-reference guides that outline the repositioning schedule and identify high-risk residents. These tools support knowledge retention and help ensure that preventive measures are applied consistently throughout every shift.

Background Analysis

In the context of Nightingale Skilled Nursing Facility, the results of the recent internal audits revealed an increased incidence of stages 1 and 2 pressure injuries in immobile residents. An examination of the documentation revealed inconsistencies in the documentation of the repositioning intervals, as well as the application of preventive measures between shifts. These observations are in line with national trends, which show that inconsistencies in documentation and preventive practice contribute significantly to pressure injury development (Gassas et al., 2025). Although the application of repositioning is widely accepted as the standard in the prevention of pressure injuries, inconsistent implementation undermines the effectiveness of this intervention.

In addition to this, the workload demands, as well as the lack of confidence among the staff, were also identified as contributing to the development of the pressure injuries. The research identified that workload demands, as well as the confidence levels of the nurse, directly influence the implementation of the prevention strategies (Gwag & Kim, 2026). During high patient acuity periods, repositioning intervals were reported to be inconsistent, particularly when staffing ratios were inadequate. Inconsistencies in the implementation of these strategies also increase the risk of early signs of skin damage not being recognized.

Pressure injuries are linked to higher morbidity rates, longer lengths of stay, and financial costs to healthcare organizations. Research has proven that the use of structured repositioning intervals can decrease the risk of injuries; however, this can only be achieved when system-level supports are in place (Asiri, 2023). These findings highlight a clear gap in consistent practice at Nightingale Skilled Nursing Facility and support the need for a standardized two-hour turning protocol to reduce preventable harm.

Conclusion

The importance of the prevention of pressure injuries is a vital quality indicator for long-term care facilities. The components of the structured two-hour repositioning schedule are goals, implementation, and accountabilities. The structured two-hour repositioning schedule seeks to reduce the occurrence of facility-acquired pressure injuries by 25% within a period of 12 weeks. The components of the structured two-hour repositioning schedule, as indicated in the study, are essential for the prevention of pressure injuries (Asiri, 2023). The objectives of the project to reduce the occurrence of new pressure injuries, enhance documentation compliance, and improve knowledge and self-efficacy are essential for the creation of a system for implementing the strategies to support a consistent approach to the prevention of pressure injuries. Indicated in the background analysis is the lack of uniform documentation, inconsistent repositioning practices, workload demands, and confidence levels on the part of the staff contributing to the rising occurrence of pressure injuries at Nightingale Skilled Nursing Facility. The background analysis is a justification for implementing the structured two-hour repositioning schedule, which is essential for addressing the gaps for the prevention of pressure injuries at Nightingale Skilled Nursing Facility, as indicated in the PICOT question.

References

Asiri, S. (2023). Turning and repositioning frequency to prevent hospital-acquired pressure injuries among adult patients: Systematic review. Inquiry, 60, 1–10. https://doi.org/10.1177/00469580231215209

Gassas, R., Alharbi, K., Fallatah, A., & Alamri, A. A. (2025). An evaluation of nurses’ compliance with pressure ulcer and fall risk assessments. Nursing Open, 12(12), 1–9. https://doi.org/10.1002/nop2.70376

Gwag, H. S., & Kim, J. A. (2026). Patient safety and quality improvement in nursing practice: Associations among workload, occupational coping self-efficacy and medical device-related pressure injury prevention. Healthcare, 14(2), 270. https://doi.org/10.3390/healthcare14020270