Taking The Pressure Off In The ICU

The purpose of our three month study was to decrease the risk, incidence and prevalence of nosocomial pressure ulcers in the adult ICU.  We investigated whether using static air products; specifically an overlay and boots on ICU patients with a Braden risk score of 16 or below, and specific nursing education would decrease those rates significantly.

Patients were determined to be at risk using the Braden Risk Assessment and/or having two or more conditions that we listed in our study as contributing risk parameters.  We provided the ICU staff education on accurate staging, documentation of pressure ulcers, and interventions.  The interventions included documentation of patients’ skin assessment each shift, providing static air product to the patient, completing a Braden score daily and listing any change in the patient’s status.

Prior to implementation of the study ICU staff education modules were completed by 52 ICU, 8 SICU and 27 CCU nurses that work in or provide cross coverage in the ICU.  90% of the staff completed the education modules.  In-services on the indications and appropriate use of static air products were provided in 2 separate timeframes prior to inception of the study.

The patients were tracked along with their outcomes.  The pre and post-study pressure ulcer prevalence and incidence data was gathered using an objective data collection tool.

ICU nosocomial pressure ulcer rate was 21% prior to the study and zero percent during the three month study.  Combining the education, weekly rounding, static air products and increased interaction by the CWON along with utilization of both the Braden Risk Assessment Scale and the list of criteria to identify patients at risk we were able to initiate early intervention. We therefore provided proactive care for the patients and achieved positive impact on the nosocomial pressure ulcer incident rate in adult ICU.