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Purpose: There is a lack of evidence as to how to prevent pressure ulcers in severely debilitated, immobile ICU patient. The staff of St. Joseph ’s CTVU reviewed 2007 pressure ulcer patient charts, and identified common clinical conditions. High risk criteria were developed and these patients received aggressive management to affect quality outcomes.
Objective: To prevent pressure ulcers for high-risk post-operative cardiovascular surgery patients.
Methods: The retrospective analysis of 2007 charts pressure ulcer patients indicated that patients who were on high doses, and multiple vasopressors; received multiple blood products in the operating room, and were mechanically ventilated post-operatively commonly broke down. Prevalence of nosocomial pressure ulcers was approximately 10%, and patients commonly developed severe pressure ulcers. In order to prevent these pressure ulcers the team chose to place these patients on air fluidized therapy (AFT) beds which provides maximal emersion and envelopment. Patients who: 1) Required vasopressors for at least 24 hours, and 2) Required mechanical ventilation for at least 24 hours post operatively were placed. Patients were stepped down from AFT when they were extubated, weaned off the majority of their vasopressors, and could bear weight.
Results: During the last 7 months of process change (February 2008 though August 2008) of 28 patients meeting criteria, 27 received the AFT bed. Only 1 patient developed a pressure ulcer while on the bed which was a Stage I ulcer. One patient did not receive AFT as she had an open sternum/chest and was considered too unstable to be moved by the physician. This patient developed a DTI, which became a Stage IV pressure ulcer prior to discharge.
Conclusion: Prevention of pressure ulcers in the severely compromised patient may require aggressive tissue off-loading using specialty beds that minimizes interface pressure and shear; however, more data is needed to confirm these initial findings.
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Objective: To prevent pressure ulcers for high-risk post-operative cardiovascular surgery patients.
Methods: The retrospective analysis of 2007 charts pressure ulcer patients indicated that patients who were on high doses, and multiple vasopressors; received multiple blood products in the operating room, and were mechanically ventilated post-operatively commonly broke down. Prevalence of nosocomial pressure ulcers was approximately 10%, and patients commonly developed severe pressure ulcers. In order to prevent these pressure ulcers the team chose to place these patients on air fluidized therapy (AFT) beds which provides maximal emersion and envelopment. Patients who: 1) Required vasopressors for at least 24 hours, and 2) Required mechanical ventilation for at least 24 hours post operatively were placed. Patients were stepped down from AFT when they were extubated, weaned off the majority of their vasopressors, and could bear weight.
Results: During the last 7 months of process change (February 2008 though August 2008) of 28 patients meeting criteria, 27 received the AFT bed. Only 1 patient developed a pressure ulcer while on the bed which was a Stage I ulcer. One patient did not receive AFT as she had an open sternum/chest and was considered too unstable to be moved by the physician. This patient developed a DTI, which became a Stage IV pressure ulcer prior to discharge.
Conclusion: Prevention of pressure ulcers in the severely compromised patient may require aggressive tissue off-loading using specialty beds that minimizes interface pressure and shear; however, more data is needed to confirm these initial findings.
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