How a Recipe for “Apple P.I.E.” Could Be Worth $1 Billion

By Patricia Turner, RN, BSN, CWS, CWOCN | November 30, 2018

With the holidays approaching, everyone’s on the lookout for the best recipes. When it comes to helping nursing staff recognize and identify the stages of pressure injuries, I’ve created one that’s hard to beat: “Apple P.I.E.” Hospitals around the country are recognizing that reducing hospital-acquired pressure injuries (HAPI’s) is not only good for patients, it’s also smart business. In fact, a recent study showed that lowering the incidence of HAPI’s by 23 percent over five years equated to an estimated savings of $1 billion. This clearly illustrates why it’s so important to promote improved pressure injury recognition and train clinicians using memorable staging analogies, and helps explains how a simple P.I.E. (Pressure Injury Explanation) recipe could be worth $1 billion.


Setting the stage

Pressure injuries, as part of their assessment, are described using the NPUAP staging system. The staging system is specific to only pressure injuries.  The stages are based on identifying and knowing the levels of skin and tissue involved in each wound. By knowing just how deep each layer goes, clinicians can more easily identify the correct stage. We also need to remember that there are some stages of pressure injuries where the patient’s skin remains intact. These pressure injuries have certain discolorations associated with them. This is useful to connect these “layers” and “colors” to something we encounter almost every day … an apple.


How it works

In the Apple P.I.E. system, each stage of pressure injury is equated with the state of an apple, from unblemished to completely eaten. For example, Stage 1 is equated with a the familiar, bright red color of an apple, Stage 4 with one eaten down to the core, and Unstageable is compared to a caramel apple. In that particular case, the caramel stands in for eschar or slough, which obscures the wound and limits the clinician’s ability to judge wound depth or tissue damage. Using a system like Apple P.I.E. helps reduce confusion around pressure injuries and empowers nurses to confidently identify their stage.


Reducing HAPI’s

These comparisons may not stimulate the appetite, but they do offer an easy and memorable way to clarify confusion around pressure injury stages. In a fast-paced hospital environment, senior clinicians may not have the time to repeatedly retrain staff to identify injury stages, undermining efforts to reduce HAPIs. Pressure injury staging doesn’t need to be difficult; patient health and system savings are too pressing too ignore. Thankfully, reinforcing training and promoting impactful hospital-wide savings can be as easy as apple P.I.E.

Empower your staff with easy-to-use education and tools for your patients’ skin health.

Categories: Expert Views, Skin Health

Patricia Turner, RN, BSN, CWS, CWOCN

Clinical Nurse Specialist

Patricia Turner, RN, BSN, CWS, CWOCN, is a clinical nurse specialist at Medline. Turner has been a registered nurse for over 32 years. Most of her career has been spent in wound care, with a special focus on preventing and treating pressure injuries. Turner became a board certified wound, ostomy and continence nurse in 2012 and has been a certified wound specialist since 2008.

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