Lightning Rounds In A Surgical Trauma ICU Helps To Decrease Pressure Ulcer Incidence

As the only Level 1 Trauma Center in our county,  patients are frequently admitted to the Surgical Trauma ICU (STICU) with severe physical and neurological trauma-related injuries.   This patient population has unique considerations for pressure ulcer prevention. Although our Pressure Ulcer Prevention Bundle (PUPB) had been in effect for five years, our STICU continued to struggle with the development of hospital acquired pressure ulcers.

To decrease the pressure ulcer incidence in the STICU, in addition to our PUPB, we implemented daily "Lightning" rounds, paying specific attention to pressure ulcer prevention elements .The rounds are now called "BED, FED, RED" rounds and they have assisted us in successfully decreasing the incidence of pressure ulcers in the STICU. 

Bed: During rounds, we note the support surface the patient is currently laying on. If they require a specialty surface (based upon Braden score and overall condition), it is ordered for the patient immediately.  We ensure that trauma patients who have not yet received clearance of their spines, are on a therapeutic firmer surface to prevent any further spinal injury and to provide pressure relief with a stable surface.  As soon as a patient's spine is cleared, they are reassessed and placed on an appropriate specialty bed .

Fed: The patient's nutrition status is addressed, specifically their NPO status, and alternate forms of nutrition are considered when the NPO status will go beyond 48 hours. 

Red:  The patient's current skin assessment is discussed, including the need for specific wound care products and skin care, which is implemented immediately.

Pressure Ulcer incidence in the STICU has decreased monthly since rounds have been implemented.  Due to the success of Lightning rounds in the STICU, we have recently instituted the "BED, FED, RED" rounds in our Medical ICU (MICU), with plans to implement rounds in all ICU units.