NURS-FPX 4020 – Improving Quality of Care and Patient Safety (Capella University)

Assessment 3 (2026): Improvement Plan In-Service Presentation – Preventing Hospital-Acquired Pressure Injuries in the ICU

Course and Assessment Positioning

Course: NURS-FPX 4020 – Improving Quality of Care and Patient Safety (Capella University, FlexPath BSN)
Assessment: Assessment 3 – Improvement Plan In-Service Presentation (based on Assessment 2 problem analysis)
Level: Upper-division BSN (quality and safety focus)
Format: 12–15 slide narrated in-service presentation or a presentation script of 1,200–1,500 words, plus a reference slide
Focus: Translating your Assessment 2 analysis of hospital-acquired pressure injuries (HAPIs) in the ICU into a practical improvement plan for frontline staff

This assessment aligns with established NURS-FPX 4020 Assessment 3 expectations that require learners to deliver an in-service education session presenting an evidence-based improvement plan to nurses and interprofessional colleagues, grounded in a previously analysed quality or safety issue.

Assessment 3 Overview

You will design and present an improvement plan in the form of an in-service education session for ICU nurses and relevant team members. The session will focus on reducing hospital-acquired pressure injuries by addressing the human, system, and environmental factors identified in Assessment 2 and explaining how the proposed plan improves quality, safety, and cost outcomes.

Intended Learning Outcomes

By completing this assessment, you will be able to:

• Propose an evidence-informed improvement plan that directly targets a defined quality and safety problem in a specific clinical setting

• Explain how the proposed plan supports improved patient outcomes, safer nursing practice, and more efficient use of healthcare resources

• Communicate the improvement plan in a clear, engaging format suitable for an in-service education session for nurses and interdisciplinary colleagues

• Demonstrate professional, scholarly communication appropriate for BSN-level nursing practice

Presentation Content Requirements

1. Title and Purpose Slide (1 slide)

• Include the presentation title, your name, course, and date

• Clearly state the purpose of the in-service in one or two sentences (for example, reducing ICU hospital-acquired pressure injuries through a focused prevention improvement plan)

2. Problem Summary and Context (1–2 slides)

• Briefly restate the ICU practice context from Assessment 2, including unit type, patient population, baseline HAPI rates, and injury severity patterns

• Summarise why hospital-acquired pressure injuries are a priority in this unit, referencing patient harm, regulatory expectations, and cost implications

• Include one or two key data points from your Assessment 2 analysis, such as incidence rates or estimated cost per injury

3. Root Causes and Contributing Factors (2–3 slides)

Use concise bullet points to recap the most significant contributors identified in Assessment 2:

• Human factors: workload pressures, competing priorities, gaps between knowledge and practice, and communication during handovers

• System and process issues: repositioning protocols that do not reflect ICU complexity, inconsistent Braden Scale reassessment, lack of electronic prompts, and inconsistent allocation of specialty surfaces

• Environment and technology: ICU room layout, availability of lifts and specialty beds, documentation burden, and reporting culture

4. Improvement Plan Overview (1 slide)

• Introduce the overarching aim of the improvement plan (for example, reducing stage 2 or higher ICU pressure injury incidence from 14% to 5% or less within 12 months)

• Identify two to three key strategies that will structure the remainder of the presentation

5. Strategy 1 – Risk-Stratified Prevention and Alerts (2–3 slides)

• Describe implementing a structured risk-stratification process that combines Braden Scale thresholds with clinical judgement for factors such as hemodynamic instability, proning, or advanced life-support therapies

• Explain how electronic health record alerts will be used to flag high-risk patients and prompt overdue repositioning or skin assessments

• Identify staff responsibilities, including bedside nurses, charge nurses, and wound-care specialists, and specify how frequently risk will be reassessed

• Briefly reference guideline-supported evidence for risk-based prevention and electronic reminders

6. Strategy 2 – Optimised Use of Specialty Surfaces and Safe Handling Resources (2–3 slides)

• Outline a risk-based protocol for allocating specialty beds and overlays so that the highest-risk ICU patients receive them first

• Describe how specialty surfaces will be monitored and re-allocated as patient risk levels change

• Address safe patient handling by describing team-based turning procedures and improved access to lift equipment

• Explain how this strategy reduces both pressure injury risk and staff injury risk, supporting patient safety and cost control

7. Strategy 3 – Workflow-Realistic Repositioning and Documentation (2–3 slides)

• Describe how repositioning schedules and documentation will be adapted to reflect ICU realities, including clinical instability and unavoidable delays

• Explain planned electronic documentation changes that make recording turns and justified exceptions more efficient

• Include a simple visual overview of the revised workflow from risk assessment to follow-up

• Emphasise how the plan supports a non-punitive learning culture that uses missed turns as improvement data rather than grounds for blame

8. Expected Outcomes: Quality, Safety, and Cost (1–2 slides)

• Identify three to five measurable outcomes, such as reduced HAPI incidence, decreased ICU length of stay, and fewer staff lifting injuries

• Include anticipated cost outcomes, such as reduced treatment costs per pressure injury and avoidance of penalties or litigation

• Explain how outcomes will be monitored, for example through monthly dashboards or protocol compliance audits

9. Roles and Responsibilities (1 slide)

Briefly outline expectations for:

• Bedside nurses

• Charge nurses and unit leadership

• Wound-care specialists or skin-care champions

• Information technology and materials management teams

10. Call to Action and Next Steps (1 slide)

• Summarise immediate expectations for staff, such as trialling the new workflow and providing feedback

• State the duration of the pilot or initial implementation period and when results will be reviewed and shared

11. References Slide (1 slide)

• List all sources in current APA format, including clinical guidelines, research studies, and quality-improvement resources

Presentation Delivery Requirements

• Length: 12–15 content slides (excluding title and references), with narration or speaker notes equivalent to 1,200–1,500 words

• Audience: ICU nurses and relevant interdisciplinary staff; language should be clear, clinically grounded, and accessible

• Evidence base: Use at least four to six recent scholarly or authoritative sources published between 2018 and 2026

• Consistency: Ensure alignment between this presentation and Assessment 2 regarding problem description, baseline data, and contributing factors

Pressure injuries in the ICU represent more than an isolated clinical complication; they reflect broader misalignment between patient risk, workflow demands, and resource allocation. Evidence suggests that a single stage 3 or 4 pressure injury can substantially increase treatment costs and prolong ICU length of stay, making prevention strategies both a clinical and financial priority (Padula et al., 2019).

Evidence from international critical-care studies demonstrates that multifaceted pressure injury prevention programmes combining risk stratification, staff education, specialty surface allocation, and workflow-integrated documentation produce significantly greater reductions in ICU-acquired pressure injuries than isolated interventions. These findings reinforce the importance of system-level improvement plans that align prevention strategies with real-world ICU constraints, rather than relying solely on individual nurse compliance (Chaboyer et al., 2018).

References

• Alderden, J. et al. (2021) Outcomes associated with hospital-acquired pressure injuries: A systematic review, Advances in Skin & Wound Care, 34(10), pp. 1–14.

• Padula, W. V. et al. (2019) Value of hospital resources for effective pressure injury prevention: A cost-effectiveness analysis, BMJ Quality & Safety, 28(2), pp. 132–141.

• Mervis, J. S. and Phillips, T. J. (2019) Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation, Journal of the American Academy of Dermatology, 81(4), pp. 881–890.

• Tayyib, N. and Coyer, F. (2016) Effectiveness of pressure ulcer prevention strategies for adult ICU patients, Worldviews on Evidence-Based Nursing, 13(6), pp. 432–444.

• Agency for Healthcare Research and Quality (2020) Preventing pressure ulcers in hospitals.

• Chaboyer, W. et al. (2018) A multifaceted intervention to prevent pressure injuries in intensive care units, American Journal of Critical Care, 27(6), pp. 486–494.

 

#Sample PPT Presentation Slides.

Preventing Hospital-Acquired Pressure Injuries in the ICU

An Evidence-Based Improvement Plan
NURS-FPX 4020: Improving Quality of Care and Patient Safety
Student Name | Capella University | January 2026

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1. Purpose and Objectives

Purpose:
Present an evidence-based improvement plan to reduce hospital-acquired pressure injuries in the ICU from 14% to below 5% within 12 months.

Key Focus Areas:

• Risk-stratified prevention with automated alerts

• Optimized specialty surface allocation

• Workflow-realistic repositioning protocols

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2. The Problem: ICU Context

Unit Profile:

• 20-bed medical-surgical ICU

• Average patient age: 62 years

• High-acuity patients: mechanical ventilation, vasopressors, CRRT

• Nurse-patient ratio: 1:1 to 1:2

Current State Data:

• 18 pressure injuries documented over 6 months

• 14% incidence rate for patients >72 hours

• 11 stage 2, 5 stage 3, 2 unstageable

• Common injury locations: sacrum, heels, occiput

Additional Metrics:

• Current incidence rate: 14%

• Repositioning compliance: 62%

• Braden Scale reassessment: 54%

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3. Why Pressure Injuries Are a Priority

Patient Impact:

• Pain, delayed mobilization, increased infection risk

• Extended ICU stays, functional decline

Regulatory and Quality Standards:

• Hospital-acquired pressure injuries classified as never events

• Linked to value-based purchasing penalties and quality rankings

Financial Burden:

• Stage 2: $10,000 per injury

• Stage 3-4: $43,000-$129,000 per injury

• Extended ICU stays: $3,000-$5,000 per day

Staff Morale:

• Moral distress when preventable harm occurs despite knowledge of prevention strategies

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4. Root Causes: Human Factors

• High Cognitive Load & Competing Priorities: Nurses manage alarms, vasopressors, procedures, and family communication; pressure injury prevention competes with more urgent tasks

• Communication Gaps at Handoff: Shift reports focus on hemodynamics; skin integrity and turning schedules often omitted

• Knowledge-Practice Gap: Staff understand principles but struggle to translate knowledge into consistent action under high-acuity conditions

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5. Root Causes: System and Process Issues

• Protocols Not Adapted for ICU Complexity: Two-hour repositioning standards do not account for hemodynamic instability, proning, or ECMO support

• Inconsistent Risk Reassessment: Braden Scale reassessed every 48 hours; no prompts for patient condition changes

• Documentation Burden: Multiple EHR screens; no automatic alerts for overdue turns

• First-Come, First-Served Surface Allocation: High-risk patients wait 12-24 hours while lower-risk patients occupy specialty beds

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6. Root Causes: Environment and Technology

• Room Layout & Equipment Access: Limited space, difficulty using lifts; specialty surfaces stored far from bedside

• Technology Workflow Interruptions: Mobile EHR terminals interfere with repositioning workflows

• Safety Reporting Culture: Staff fear reporting injuries may be interpreted as individual failure

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7. Strategy 1: Risk-Stratified Prevention

Enhanced Risk Assessment:

• Braden Scale plus ICU-specific risk factors for high-acuity patients

Electronic Health Record Alerts:

• Automated alerts flag patients with Braden scores <13

• Notifications for overdue repositioning by 30 minutes

• Prompts for overdue skin assessments

Evidence Base:

• Automated reminders improve repositioning compliance when integrated into workflow (Tayyib & Coyer, 2016)

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8. Strategy 2: Optimized Specialty Surfaces

Risk-Based Allocation Protocol:

• Highest-risk patients (Braden <10 or multiple risk factors) receive specialty beds within 4 hours

• Medium-risk patients (Braden 10-12) receive alternating-pressure overlays

• Daily review and reallocation based on patient risk

Safe Patient Handling:

• Team-based turning procedures for ECMO, proned, or line-heavy patients

• Lift equipment staged in-unit to reduce delays

• Pre-turn huddles to coordinate staff and equipment

Dual Benefit:

• Reduces both pressure injury risk for patients and musculoskeletal injury risk for staff

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9. Strategy 3: Workflow-Realistic Repositioning

Adapted Repositioning Schedules:

• Standard two-hour turns for stable patients on specialty surfaces

• Modified intervals (1-3 hours) based on clinical stability and risk

• Document delays with clinical rationale in non-punitive format

Streamlined Documentation:

• One-click repositioning documentation in EHR

• Dropdown menu for justified exceptions (procedures, instability, family presence)

• Simplified skin assessment checkboxes

Culture Shift:

• Use missed turns as improvement data, not grounds for blame

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10. Implementation Workflow

1. Admission or Status Change: Complete Braden Scale + ICU risk factors

2. EHR Alert Triggers: High-risk patients flagged; surfaces requested

3. Surface Allocation: Within 4 hours based on risk tier

4. Repositioning Schedule: Tailored to patient stability and risk

5. Documentation and Alerts: One-click turns; overdue alerts

6. Daily Review: Charge nurse reviews patient risk and surface allocation

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11. Expected Outcomes: Quality, Safety, and Cost

Quality Outcomes:

• Reduce stage 2+ injuries from 14% to <5%

• Improve repositioning compliance to >90%

• Increase Braden reassessment to >95%

Safety Outcomes:

• Decrease patient pain and complications

• Reduce staff lifting injuries

• Strengthen safety reporting culture

Cost Outcomes:

• Avoid $400,000-$600,000 in treatment costs

• Reduce ICU length of stay

• Avoid regulatory penalties

Monitoring Methods:

• Monthly pressure injury incidence dashboards

• Weekly compliance audits

• Quarterly cost analysis

Projected 12-Month Impact:

• Prevent 10-12 pressure injuries, saving $200,000-$400,000

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12. Next Steps and Call to Action

Immediate Actions for Bedside Nurses:

• Complete Braden Scale assessment at admission and with status changes

• Respond to EHR alerts for high-risk patients and overdue repositioning

• Use one-click documentation for turns and skin assessments

• Request specialty surfaces through charge nurse when Braden <13

• Report newly identified injuries using non-punitive incident reporting

Implementation Timeline:

• Pilot begins February 2026

• Full implementation April 2026

• First outcome review May 2026

Message to Staff:
Your engagement is critical to preventing harm and improving patient outcomes.

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13. References

• Alderden, J., Zhao, Y. L., Zhang, Y., Thomas, D., & Butcher, R. (2021). Outcomes associated with hospital-acquired pressure injuries: A systematic review. Advances in Skin & Wound Care, 34(10), 1-14. https://doi.org/10.1097/01.ASW.0000751409.26879.0a

• Chaboyer, W., Bucknall, T., Webster, J., McInnes, E., Gillespie, B. M., Banks, M., … & Whitty, J. A. (2018). A multifaceted intervention to prevent pressure injuries in intensive care units. American Journal of Critical Care, 27(6), 486-494. https://doi.org/10.4037/ajcc2018449

• Padula, W. V., Pronovost, P. J., Makic, M. B. F., Wald, H. L., Moran, D., Mishra, M. K., & Meltzer, D. O. (2019). Value of hospital resources for effective pressure injury prevention: A cost-effectiveness analysis. BMJ Quality & Safety, 28(2), 132-141. https://doi.org/10.1136/bmjqs-2017-007505

• Tayyib, N., & Coyer, F. (2016). Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: A systematic review. Worldviews on Evidence-Based Nursing, 13(6), 432-444. https://doi.org/10.1111/wvn.12177