Date of Award

8-14-2026

Document Type

Capstone

Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences

Department

Nursing

Major Advisor

Diane O. Chlebowy, PhD, RN, CNL

Abstract

Background: Acute skin failure (ASF) can mimic a hospital-acquired pressure injury (HAPI), particularly among critically ill patients experiencing hypoperfusion and multisystem organ dysfunction. The lack of a standardized diagnostic approach may contribute to misclassification, inappropriate interventions, and inaccurate quality reporting.

Purpose: This study evaluated the use of the Skin Failure Clinical Indicator Scale (SFCIS) to identify skin injuries potentially consistent with ASF that would support reclassification. This study also examined associations between SFCIS scores, in-hospital mortality, length of stay, and individual comorbidities.

Methods: A retrospective chart review was conducted at a 32-bed adult intensive care unit in a suburban hospital in the southeastern United States. The final sample included 35 adult patients admitted between 2023 and 2025 who developed a Stage 3, Stage 4, unstageable, or deep tissue pressure injury (DTPI) attributed to their ICU stay. Patients were classified as high risk or non-high risk using the SFCIS. Descriptive statistics, Fisher’s exact tests, Wilcoxon rank-sum tests, Spearman correlations, and univariate logistic regression were used to analyze the data.

Results: Twenty-two patients (62.9%) were classified as high risk for ASF. In-hospital mortality was significantly higher among high-risk patients than among non-high-risk patients (55.0% vs. 7.7%, p = .010). Each 1-point increase in SFCIS score was associated with a 19% increase in the odds of in-hospital mortality (OR = 1.19, 95% CI [1.04, 1.43], p = .031). Higher SFCIS scores were also associated with longer hospital stays (Spearman’s ρ = .373, p = .027) and ICU stays (ρ = .536, p < .001). Application of the SFCIS supported potential reclassification of 22 of 87 identified HAPIs (25.3%) as ASF and would have reduced reportable PSI-03 eligible pressure injuries by 50%.

Conclusion: The SFCIS may provide a clinically meaningful, standardized method for identifying ASF among critically ill patients. Its use could improve diagnostic accuracy, documentation, prognostic communication, goals-of-care discussions, and quality reporting. Larger, prospective, and more diverse studies are needed to validate these findings.

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Available for download on Saturday, July 22, 2028

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