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Goal: Reduce Hospital Acquired Pressure Ulcers (HAPU) to the benchmark of the 50th percentile of Magnet organizations which is 2.10%. MICU’s specific target is below 8.02%.
METHODS: MICU Unit Practice Council (UPC) identified problems and potential solutions. The group established a Skin Breakdown Prevention Protocol which includes evidence based practice. The protocol was based on review of unit data, and supported by Braden recommendations. The protocol includes a bed decision tree that increases use of low air-loss surfaces. The protocol also recommends that pressure relief boots and sequential compression devices be removed for 30 minutes each 12 hours. This recommendation was developed because of a high incidence of pressure ulcers on heels and ankles. In March 2009, a goal was to increase identification of pressure ulcers present on admission by having two staff members assess each patient’s skin on arrival to the unit. If a pressure ulcer is identified, the physician is notified for orders or a Wound Nurse consult.
Results: Weekly “Skin Rounds” were conducted by the team in March 2010. During rounds the NDNQI information is monitored. Rounds were used as an educational opportunity to validate documentation. Weekly data analysis revealed 45% of unit acquired pressure ulcers occur on non-traditional site, i.e. around tracheostomy sites. Targeting patients with a Braden of 14 or less on admission to the MICU were identified and placed on pressure reducing low air-loss surfaces. Since March 2010, the number of pressure ulcers identified on admission has increased. The MICU pressure ulcer rate has dropped from 18.8% in January 2010 to 0% on the July 2010 NDNQI survey.