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Purpose: To determine whether weekly skin assessment rounds and bedside education by a Certified Wound Ostomy Nurse (CWON) have a measureable effect on the incidence of hospital-acquired pressure ulcers in the intensive care unit (ICU).
Background: Pressure ulcer development, a significant problem associated with increased morbidity and mortality, is a recognized nursing quality indicator. ICU patients are particularly vulnerable due to compromised nutritional status, limited mobility, and the effects of poor perfusion. Care may require challenging and often opposing nursing tactics, e.g., head of bed elevated > 30 degrees for prevention of ventilator-associated pneumonia may pose a risk for sacral pressure ulcer development. The Centers for Medicare and Medicaid Services (CMS) have ruled that a higher DRG payment no longer will be assigned for hospital-acquired pressure ulcers.
Methods: Weekly rounding by a CWON with an ICU Wound Care Team Nurse was initiated in the Cardiovascular and Surgical ICUs. Braden subscale scoring influenced implementation of evidence-based practices such as heel elevation, use of barrier ointment, and nutrition referrals. Accurate staging and documentation were completed, and recommendations for specialty support surfaces were provided.
Results: Data suggest that prevention surfaces are being used sooner, and improved accuracy in differentiating pressure ulcers from incontinence-associated dermatitis, moisture lesions and skin tears has occurred. Use of breathable underpads and devices to relieve heel and occipital pressure has increased. ICU prevalence rates for pressure ulcers have decreased, and the size and severity of those that develop have lessened.
Outcomes: The presence and accessibility of the CWON proficient in risk assessment, skin inspection, prevention protocols, and bedside education has launched an ICU culture change. Nurses are empowered to initiate preventive measures earlier, patients benefit from avoidance of a serious complication. The institution benefits from reduced length of stay, increased patient satisfaction, and compliance with best practice recommendations.
Background: Pressure ulcer development, a significant problem associated with increased morbidity and mortality, is a recognized nursing quality indicator. ICU patients are particularly vulnerable due to compromised nutritional status, limited mobility, and the effects of poor perfusion. Care may require challenging and often opposing nursing tactics, e.g., head of bed elevated > 30 degrees for prevention of ventilator-associated pneumonia may pose a risk for sacral pressure ulcer development. The Centers for Medicare and Medicaid Services (CMS) have ruled that a higher DRG payment no longer will be assigned for hospital-acquired pressure ulcers.
Methods: Weekly rounding by a CWON with an ICU Wound Care Team Nurse was initiated in the Cardiovascular and Surgical ICUs. Braden subscale scoring influenced implementation of evidence-based practices such as heel elevation, use of barrier ointment, and nutrition referrals. Accurate staging and documentation were completed, and recommendations for specialty support surfaces were provided.
Results: Data suggest that prevention surfaces are being used sooner, and improved accuracy in differentiating pressure ulcers from incontinence-associated dermatitis, moisture lesions and skin tears has occurred. Use of breathable underpads and devices to relieve heel and occipital pressure has increased. ICU prevalence rates for pressure ulcers have decreased, and the size and severity of those that develop have lessened.
Outcomes: The presence and accessibility of the CWON proficient in risk assessment, skin inspection, prevention protocols, and bedside education has launched an ICU culture change. Nurses are empowered to initiate preventive measures earlier, patients benefit from avoidance of a serious complication. The institution benefits from reduced length of stay, increased patient satisfaction, and compliance with best practice recommendations.