According to the
Agency for Healthcare Research and Quality (AHRQ), each year an estimated 2.5 million patients in the United States develop a pressure ulcer/pressure injury (PU/PI), contributing to around 60,000 deaths and more than $11 billion in treatment costs. While some PUs/PIs are unavoidable, many are preventable and continue to occur despite the existence of evidence-based prevention guidelines.
Since 2008, the
Centers for Medicare & Medicaid Services (CMS) has classified Stage 3 and Stage 4 pressure injuries that develop during hospitalization as Hospital-Acquired Conditions (HACs). Under this policy - effective for discharges on or after October 1, 2008 - hospitals do not receive additional reimbursement for cases where a hospital-acquired pressure injury (HAPI) was not present on admission. In practice, this means the case is reimbursed as if the secondary diagnosis (HAPI) did not exist.
To achieve these goals, hospitals can adopt proactive, system-wide approaches to prevention, empowering clinicians with the right tools, education, and documentation practices to identify risk early and prevent avoidable harm.
How Hospitals Can Strengthen HAPI Prevention Programs
Effective HAPI prevention requires a coordinated, multidisciplinary strategy that aligns bedside care, education, and technology.
Successful programs include three core elements:
- Evidence-based education and training for all clinicians
- Standardized preventive care
- Consistent documentation and communication
Evidence-Based Staff Education and Standardized Preventive Care
Building staff awareness, confidence, and competency is foundational to HAPI prevention. Evidence-based staff education includes the following HAPI prevention elements:
- Structured Risk Assessment: Identify risk early and reassess frequently. Use validated tools (e.g., Braden Scale) upon admission, discharge, and at defined intervals based on patient acuity. Supplement with clinical judgment to capture additional risk factors.
- Comprehensive Skin Assessment: Perform head-to-toe skin assessments focusing on bony prominences and areas in contact with medical devices.
- Individualized Care Plan: Develop personalized, evidence-based prevention bundles addressing pressure redistribution, repositioning, mobility, nutrition, moisture management, and shear reduction. Embedding these practices into daily workflows promotes consistency across nursing teams.
- Pressure Redistribution: Use high-specification foam mattresses and seating surfaces to redistribute pressure and prevent PU/PI.
- Repositioning: Regularly reposition patients based on individual needs, using techniques like 30° tilted side-lying positions and ensuring adequate support for seated individuals.
- Mobility and Activity: Implement early mobility programs to enhance perfusion and reduce immobility-related risk.
- Nutrition: Screen nutritional status upon admission and refer at-risk individuals to dietitians.
- Moisture and Shear Management: Provide staff training on skin care, barrier products, and safe handling to reduce shear forces.
- Medical Device Management: Ensure proper fit and securement of medical devices, use prophylactic dressings, and educate staff on device-related PU/PI prevention
- Care Coordination: Facilitate seamless communication between care teams during transitions to maintain continuity of preventive measures.
For details, refer to WoundReference topic "Pressure Ulcers/Injuries - Prevention" and "Pressure Ulcers/Injuries -Coordination of Care".
Optimized Documentation and Communication
Accurate staging, photo documentation, and timely interprofessional communication are critical. Standardized documentation templates and decision-support tools - such as those available through WoundReference - enhance accuracy, reduce reporting errors, and support audit readiness.
Educate and Engage the Care Team
Prevention success depends on an informed and motivated workforce. Competency-based training, real-time feedback, and interactive learning tools keep clinicians engaged and reinforce adherence to best practices.
Use Data to Drive Improvement
When prevention, documentation, and education are aligned, hospitals not only reduce avoidable harm but also strengthen financial performance and compliance - creating measurable value for both patients and organizations.
Bridging the Gap: Why HAPI Prevention Competency Programs Are Essential
HAPIs often arise NOT from neglect, but from gaps in knowledge, communication, and consistency.
As part of a system-wide HAPI prevention initiative, ongoing competency programs help hospitals operationalize their prevention goals by:
- Standardizing care across units and facilities
- Improving accuracy in assessment, staging, and documentation
- Reinforcing critical interventions such as repositioning, offloading, and skin inspection
- Ensuring regulatory compliance with CMS and accrediting bodies
- Providing continuing education (CE) credits, enhancing staff motivation and retention
When integrated into a broader prevention strategy and supported by evidence-based and current education, CE credit, and audit-ready documentation, ongoing competency programs become important drivers for reducing HAPI incidence and promoting a culture of accountability.
A Real-World Case: From Knowledge Gaps to Zero HAPI
A multi-site hospital system serving both acute and post-acute settings set out to achieve its quality goal: Zero Hospital-Acquired Pressure Injuries.
The Challenge
The hospital needed to train hundreds of clinicians while ensuring consistency across facilities. New hires received only brief wound care orientation, and no structured competency mapping existed. Educators also faced administrative burdens - tracking completion, documenting progress, and generating compliance reports manually.
The Solution
As part of a comprehensive, system-wide HAPI prevention initiative, the hospital partnered with WoundReference to implement a HAPI Prevention Competency Module built from validated templates and integrated directly into its learning management system. Download the case study for details.
Each clinician completed a baseline assessment to identify knowledge gaps, followed by interactive, scenario-based modules tailored to real-world cases. The digital design enabled anytime, anywhere access, making participation practical for busy nurses and allied health professionals.
Engagement Through Innovation
Clinicians embraced the program enthusiastically.
- Gamified quizzes and interactive design turned learning into a meaningful, practice-relevant experience.
- Nearly 100% of staff participated, thanks to strong support from leadership, clinical educators, and WoundReference’s implementation team.
Proven Results: Knowledge, Confidence, and Zero HAPI
Within the first year of the system-wide prevention initiative, including the competency program, outcomes were transformative:
- Zero Stage 3–4 HAPIs reported system-wide
- 25% improvement in knowledge scores (64% → 80%+)
- 80% reduction in educator administrative time through automated tracking and reporting
- 94% of clinicians agreed the program improved the quality of care they deliver
Competency Programs within a System-wide HAPI Prevention Initiative as a Driver of Savings
As part of a comprehensive HAPI prevention strategy, competency programs deliver measurable clinical and financial value by:
- Preventing unreimbursed HAPI cases and associated costs
- Reducing educator workload and manual administrative time
- Supporting CE requirements efficiently
- Lowering medico-legal risk through accurate documentation and compliance tracking
By combining education, technology, the hospital not only improved care standards but also optimized resource allocation.
Conclusion: From Initiatives to Impact - The Path to Zero HAPI
- HAPI prevention is more than a checklist - it’s a mindset grounded in education, accountability, and collaboration.
- When organizations implement system-wide HAPI prevention programs and embed structured competency programs within them, they turn prevention goals into measurable results.
- As this case shows, achieving Zero HAPIs is not only possible - it’s sustainable, achievable, and cost-effective when competency is part of the system-wide strategy.
Resources
Learn how WoundReference can help your institution achieve Zero HAPI.
- Read the complete case study
- Access more resources on HAPI Prevention and Competencies
- Empower clinicians to quickly access evidence-based, referenced answers at the point of care with the AI-enhanced Hospital-Acquired Pressure Injury Frequently Asked Questions (HAPI FAQ) in WoundReference My WAI.
- Book a demo to explore our point-of-care and competency-based training solutions for acute and post-acute care settings
FAQs About Competency-based Training Programs To Help Prevent HAPI (Hospital Acquired Pressure Injury)
- 1. How does staff education and competency-based training programs help prevent HAPIs?
- They standardize wound care knowledge, ensure consistent clinical practice, and provide measurable education that reinforces prevention techniques across all staff levels.
- 2 How often should competency programs be updated?
- At least annually - or more frequently when guidelines or best practices change - to maintain alignment with current evidence and regulatory requirements.
