A Formative Program Evaluation of a Performance Improvement Project Charter: HAPI Reduction

Abstract

Background: Hospital-acquired pressure injuries (HAPIs) result in patient morbidity, prolonged hospital stays, and increased healthcare costs. The organizational benchmark established by Banner Health is to maintain fewer than 2.95 HAPIs per 1,000 patient discharges. Banner Thunderbird Medical Center (BTMC) continues to report rates higher than the organizational average, with the highest rate being 6.3 HAPIs per 1,000 patient discharges, resulting in extended hospital stays and annual costs that exceed $2.8 million. Purpose: The aim of this project is to assess the success of Banner’s HAPI prevention program, which was implemented in March 2024. The goal of Banner’s HAPI prevention program is to increase staff compliance with HAPI interventions and proper documentation for high-risk patients to achieve the goal of fewer than 2.95 HAPI events per 1,000 patient discharges at BTMC by December 30, 2025. The purpose of this formative evaluation is to examine the progress of the performance initiative, including baseline data from January 1, 2023, through September 30, 2025. The goals include identifying current gaps, monitoring early implementation, and evaluating staff engagement. Methods: This formative evaluation utilized the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) in conjunction with the CDC Program Evaluation Framework. Participants included nursing staff—registered nurses (RNs) and patient care technicians (PCTs)—across intensive care units (ICUs), progressive care units (PCUs), and medical-surgical units (MS). Data was collected through monthly adherence audits, surveys, pre/post quiz scores and training evaluations following participation in the HAPI Bootcamp education sessions. A quantitative analysis was completed by analyzing trends in participation, knowledge gains, HAPI rates, and adherence. A qualitative analysis was conducted by analyzing the open-ended survey feedback. Then the project assessed progress toward HAPI rates of ≤2.95/1,000 discharges and if that goal was attained. Results: From 2023 to 2025, BTMC’s overall HAPI rate decreased from 4.26 to 3.02, reflecting a downward trend following implementation of the HAPI Bootcamp intervention. The Medical-Surgical Units achieved the greatest reduction of 35.4%, followed by the Progressive Care Units with 20.3%, and the Intensive Care Units demonstrated a 21.6% reduction but remained to have the highest rates compared to the other units at BTMC. Conclusions: The formative evaluation indicated BTMC’s HAPI prevention program was practical, sustainable, and adaptable for long-term use. Continued attention to documentation accuracy and data quality is necessary for maintaining progress toward the target of ≤ 2.95 HAPIs per 1,000 patient discharges by December 2025.