A Reactionary Practice Approach to Eliminate Hospital/Unit Acquired Pressure Ulcers in the Intensive Care Unit

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A Reactionary Practice Approach to Eliminate Hospital Acquired/ Unit Acquired Pressure Ulcers in the Intensive Care Unit

A startling increase in the percentage of patients with pressure ulcers of a twenty-six bed intensive care unit in a 214-bed, urban Nevada hospital gave rise to nursing practice innovations that dramatically changed the course of patient outcomes over a twelve month period.

The purpose of this presentation is to demonstrate the impact nursing practice changes make on the outcomes of high risk patient populations.  The National Data Base for Nursing Quality Indicators (NDNQI) pressure ulcer prevalence survey demonstrated 26.32% of the patients in the Intensive Care Unit had hospital acquired/unit acquired pressure ulcers during the second quarter, 2008 survey.  This percentage dropped to 0% by second quarter, 2009, as a result of innovative changes in practice.

Clearly, the objective was to address the situation with every resource available and reverse this trend as quickly as possible.  The following strategies facilitated the dramatic shift in patient outcomes:

Inception of the “Wound Warrior” program to the ICU, capital purchases of specialty mattresses with alternating air flow pumps, heel lift suspension boots, plantar flexion treatment boots, and foam padding for oxygen tubing were preventative and treatment modalities not used consistently in the past.  Staff education on proper identification, prevention, management and documentation of pressure ulcers heightened awareness and changed the culture of the critical care nursing practice. Daily monitoring of serum albumin, and/or prealbumin levels generated timely nutritional consults; weekly grand/bed rounding included the attending nurse, the nurse educator, charge nurse, CWOCN, dietitian, ICU Director, and other ad hoc participants. 

The combination of these interventions and strategies have become standard practice for the Intensive Care Unit and have contributed to consistent 0% pressure ulcer prevalence over the past three quarters of the 2009 NDNQI surveys.