No pressure on you! Eliminating pressure ulcers in the ICU

Purpose: Patients in the intensive care unit are at high risk for developing skin break down and pressure ulcers secondary to bedrest, poor perfusion, inadequate nutrition, edema, and other factors associated with disease state.  Purposes of the project were: heighten importance of skin integrity and risk assessments, reduce nosocomial pressure ulcers, and eliminate reportable pressure ulcers in the intensive care unit.

Description: The Minnesota Hospital Association (2007) sponsors a best practice Safe Skin project for pressure ulcer prevention. The comprehensive skin safety program utilizes clinical wound ostomy continence guidelines, ICSI Skin Protocol and lessons learned from adverse health event.  In July 2010, the ICU rolled out a three tiered initiative starting with double checking skin inspection and body diagram documentation of new patients admitted and transferred into the ICU.  Second tier was a standardized bedside tool to report patient skin status including skin protocols, patient positioning, therapies, protective surfaces, pressure ulcer staging, wound consulting and devices. The tool remained at the bedside and was coupled with the body diagram for concise reporting. Third tier was a charge nurse report tool used to track ICU patients at risk for skin alteration or existing skin issues and serve as a trigger for wound ostomy rounds.

Evaluation:  Three months prior to the nursing interventions, the monthly ICU nosocomial pressure ulcers greater than stage one were 8, 2, and 6, with two being reportable pressure ulcers. Hospital wide, these numbers were 23, 9, and 15. Three months post intervention, the monthly ICU nosocmial pressure ulcers decreased to 3, 1, and 1, with zero reportable pressure ulcers. The house wide monthly incidence decreased to 7, 2, and 5 respectively. The ICU skin initiative has dramatically impacted patient care in the ICU and created momentum throughout the entire hospital.