It's About Time, Talent, & Treasure: Pressure Ulcer Prevention in the ICU

Purpose: NDNQI pressure ulcer audits for the 3rd quarter of 2009 in the Intensive Care Unit revealed  a 15% prevalence rate and a 10% Hospital acquired rate. This presentation will describe how utilization of all available resources and hardwiring of key preventative behaviors led to improved patient outcomes.

Objective:  To engage the ICU staff to recognize their accountability in pressure ulcer prevention.

Strategies/Interventions: 

     Time:

     • Formation of ICU Wound Prevention Committee.  Meets monthly and consists of unit supervisor, staff RN, unit tech, and CWOCN

     • Hourly rounding with attention to position, potty, pain, possessions.

     • Turning clocks in rooms with hardwired process to turn patients every 2 hours.

     Talent:

     • Multidisciplinary bedside rounds are held every M,W,F.  This group includes ICU staff RN, supervisor, and director as well as Case Manager, Physical Therapist, Speech Therapist, Pharmacist, Chaplain, Social Worker and CWOCN. The caregivers know that they will be asked about the patients risk and skin assessment.  The multiple areas of expertise are right there to provide input and early intervention.

     • Education: Formal CE offerings, point-of-care and unit based inservices and workshops for unit techs were given.

     Treasure:

     • Nurse input led to the acquisition of several products needed to provide optimal preventative skin care including turning wedges, off-loading heel boots, barrier incontinent wipes, and extra absorbent incontinent pads.

     • A laminated Dressing Selection Guide with pictures and corresponding products was placed in lounge and supply room.

Outcome: The hospital acquired pressure ulcer rates in out ICU have been 0% for the last 3 quarters of the NDNQI audit. Comprehensive education, multidisciplinary team involvement and staff engagement was critical to this success.