Critical Care Pressure Ulcer Prevention: Back to Basics

Purpose: Critical Care units (CCU) provide a unique setting for pressure ulcer prevention. Patients in the CCU are at a higher risk for developing pressure ulcers due to several risk factors assessed in the Braden Scale (sensory, moisture, activity, mobility, nutrition, friction and shear).Take into consideration a 30 bed general CCU in a level II trauma center. Over the past year, on average, the CCU has not been meeting benchmark standards established by CalNOC/NDNQI. Standards of care in place during this time included turning patients every two hours, the identification and treatment of pressure ulcers and an incontinence protocol. So, why is our hospital acquired pressure ulcer rate so high? Let’s get back to basics. Patient turning in adherence to the established standard of care is a basic nursing intervention for the prevention of pressure ulcers. A survey of CCU nursing staff revealed that the staff knows a patient with a Braden score of less than 18 is at risk for developing a pressure ulcer, and a primary intervention in the prevention of pressure ulcers is turning. So, are our nurses turning their patients every two hours?

Methodology:  A Pilot study, using silent observation, was developed to assess staff adherence to the patient turning standard of care. Patient turning over a 12 hour shift was observed for 40 patients.  

Statistics: The study analyzed relative frequencies using data gathered during both day and night shift.  

Results: On average, 17.2% of the patients were consistently turned every two hours (10.5% on day shift and 23.8% on night shift).  

Conclusion: Despite random charting audits showing consistent patient turning every two hours, the results of the pilot study suggest the standard of care for patient turning is not being upheld.   These results warrant further investigation into the topic.