Evaluating the Impact of Epic Integration and Dual Registered Nurse Check-Off on Pressure Injury Prevention Workflow Compliance

Background Hospital-acquired pressure injuries (HAPIs), particularly sacral and heel injuries, remain a persistent challenge in critical care settings, leading to increased morbidity, mortality, and healthcare costs. Purpose This quality improvement project aimed to improve compliance with a pressure injury prevention (PIP) workflow by integrating a dual RN check-off system within EPIC, thereby reducing sacral and heel pressure injuries. The project sought to enhance accountability, standardize documentation, and optimize compliance with evidence-based PIP measures. Methodology A Plan-Do-Study-Act (PDSA) framework guided the project implementation in an oncologic intensive care unit (ICU). Key interventions included: (1) EPIC integration of a dual RN check-off system to improve accountability in pressure injury prevention measures, (2) structured nursing education sessions addressing knowledge gaps, and (3) compliance tracking through audit reports. Pressure injury incidence and compliance with documentation protocols were monitored through descriptive statistics, compliance audits, and incidence tracking. Results Implementation of the dual RN check-off system resulted in a 75% reduction in sacral and heel pressure injuries during the intervention period. Compliance with pressure injury prevention protocols progressively improved following educational reinforcement, system integration, and real-time feedback mechanisms. Implications Findings highlight the effectiveness of structured verification processes, EPIC integration, and ongoing education in improving compliance and reducing pressure injuries. Expansion to other ICU settings is feasible with strong leadership support and interdisciplinary collaboration for sustainability. Future efforts should focus on continuous education, workflow optimization, and reinforcement strategies to sustain compliance and reduce HAPIs.