The Pressure Ulcer Prevention Care Bundle: A Collaborative Approach to Preventing Hospital-Acquired Pressure Ulcers in Adult Cardiac Surgery Patients

Purpose

The Pressure Ulcer Prevention Bundle is a collaborative approach designed to achieve a reduction in the incidence of hospital-acquired pressure ulcers (HAPUs) in the adult cardiac surgery patient population of UAB Hospital.

Background

The incidence of HAPUs in the adult cardiac surgery patient population exceeded the University Hospital Consortium (UHC) benchmark. 35% of the skin breakdowns were deep tissue injuries (DTIs) presenting within 48 hours after surgery. DTIs occurring in this time period are considered to originate during the intra-operative period. It was determined that achieving a reduction in skin breakdown would require a collaborative approach between the Cardiovascular Intensive Care Unit (CICU) and the Cardiothoracic Operating Room (CVOR).

Methods

A standardized set of preventive nursing interventions, i.e. a “care bundle” were developed and implemented to reduce perioperative pressure injuries. The nursing measures of the pressure ulcer prevention bundle are initiated in the CVOR and continue after the patient is transferred to the CICU. The components of this Care Bundle are:

• Skin assessment
• Pressure reduction/Redistribution
• Avoidance of  friction and shearing
• Moisture management

The incidence of HAPUs was monitored in CICU bi-weekly pre and post implementation.

Results

Prior to initiation of the Bundle, 153 patients were audited for skin breakdown from October 2009 through the first week of July 2010. 19 incidents of new skin break down were confirmed resulting in a 13% overall incidence of breakdown. After implementation, 36 patients were audited from mid July through August 2010 and there was no new skin breakdown detected on these patients.

Conclusion

Application of a collaborative pressure ulcer prevention bundle did prove effective at reducing the incidence of HAPUs in adult cardiac surgery patients at UAB hospital. Continued application of the Bundle and monitoring will be necessary to validate efficacy of this approach to HAPU prevention.