Saving Skin in the ICU and Beyond

Saving Skin in the ICU and Beyond

PURPOSE: Decreasing hospital acquired pressure ulcers (HAPU) in the hemodynamically unstable critical care patient is challenging.  HAPU rates in the ICUs at our community cardiac and trauma hospital were unacceptable.

OBJECTIVES: The objective was to decrease our pressure ulcer rate by 75 %. The challenge was to get sufficient buy in from the critical care staff to save the patient’s skin integrity.  

OUTCOMES: HAPU rates in our ICU were successfully decreased by implementing simple, unique strategies:

• Random rounds by the WOC RN to assess frequency of repositioning
• Pressure Ulcer education by the WOC RN
• Implementation of 2 RN skin assessment on admission to capture existing skin issues
• Trial and acceptance of gel positioners typically used in the operating room to provide subtle, sustainable, effective turns
• Reduction of bed linens under the patient
• Consistent use of a new skin care product line
• Research and implementation by the ICU staff of a “butt bundle” unique to their needs

The success in the ICU translated to a decrease in HAPU housewide as education and consistent use of evidence based practice was implemented in all patient populations.  There is an increased awareness of the role of the WOC RN.  Current and future projects include:

• New tracheostomy care procedure
• Pressure Ulcer Prevention (PUP) program on the medical unit
• Pressure redistribution surfaces for procedure tables
• New skin order sets for nursing
• New electronic documentation for the WOC RN
• Patient and family pressure ulcer education brochure