Safeguarding Against Hospital-Acquired Pressure Injuries for Dark Skin Tones: A Quality Improvement Initiative

PurposeThe quality improvement (QI) initiative integrated the use of the Monk Skin Tone (MST) scale into routine nursing skin assessments to reduce hospital-acquired pressure injuries (HAPIs) among patients with dark skin tones (DST). The project addressed disparities in early detection of subtle skin changes, which are less visible in DST, and sought to advance equity in patient safety. Participants and SettingThe initiative was implemented in 900-bed, academic Level I trauma hospital in Los Angeles, California. Seventy-nine registered nurses (RNs) from the Medical Unit participated, excluding agency, float pool, and nurse residency program nurses. Implementation phase was from May to July 2025. ApproachGuided by the Plan-Do-Study-Act (PDSA) framework, the MST scale was embedded into comprehensive skin assessment protocols. RNs received structured training and education, laminated MST badge buddies, and documentation reinforcement within the electronic health record (EHR). Compliance was monitored through chart audits and electronic data capture documentation review. OutcomesPre-implementation HAPI incidence was 3.18 per 1,000 patient days. Post-implementation, incidence decreased to 0.18, representing a 94% reduction. Among DST patients, only 2% developed HAPIs. Nursing compliance with MST documentation reached 95%, surpassing the 60% benchmark. Implications for PracticeIntegration of the MST scale improved documentation accuracy, reduced disparities in PI detection, and enhanced nurse compliance in skin assessments and documentation. Sustained adoption requires embedding MST training into staff onboarding, continuous education, and EHR workflows. Expansion across inpatient and outpatient settings may further advance equity, patient safety, and organizational performance.