Adventist Health System
Office of Clinical Effectiveness
Hospital Harm – Hospital-Acquired Pressure Injury

We recommend caution in proceeding with this electronic measure. Capturing pressure injury harms is dependent on accurate and precise documentation in the appropriate extractable fields in the electronic health record. Inaccurate pressure injury documentation may lead to duplicate and/or missed captures. For example, wounds other than pressure injuries (such as surgical incisions, arterial and venous ulcers) are often inaccurately documented and staged as pressure injuries. We have determined that pressure injury staging and wound progression documentation by a Wound Ostomy Continence Nurse (WOCN) is the gold standard. However, WOCNs often document in progress notes, which may be a free text field, and may not be extractable in the EHR.
Present on admission pressure injuries not documented within the first 24 hours of admission are sometimes captured as hospital acquired pressure injuries. Timely documentation is essential to accurately capture present on admission pressure injuries. In addition, clearly specifying the appropriate extractable fields that must be used to document skin integrity is essential to capturing this harm.