From Mission Impossible to Mission Preventable: The Journey of Diffusing Pressure Ulcer Prevention into Critical Care Practice

Background:  Critical care unit incidence of hospital acquired pressure ulcers (HAPU) remained unacceptably high despite empirical evidence showing pressure ulcer prevention reduces HAPUs.  Regardless of a strong pressure ulcer prevention knowledge base, the critical care nurses maintained that it has been impossible to prevent a pressure ulcer in the ‘very sick’ critical care patient.  The critical care manager, clinical nurse specialist (CNS) specializing in pressure ulcer prevention and wound care nurse practitioner have developed a new strategy to reduce the number of critical care acquired pressure ulcers.  

Purpose:  To increase critical care nurses use of pressure ulcer prevention in reducing the number of acquired critical care pressure ulcers. 

Strategy and Implementation:  Roger’s Diffusion of Innovation Theory guided the critical care pressure ulcer prevention project.  The theoretical framework helped identify the major barriers influencing nurses’ understanding and “can do” attitude about reducing the number of unit acquired pressure ulcers.  Improvement strategies included:  daily posting of the number of days between unit acquired pressure ulcers; skin rounds as part of bedside report initiated by the ‘off-going nurse’; daily pressure ulcer rounding by the CNS; identification of critical care patients at greatest risk for pressure ulcer development; and establishment of repositioning buddies. 

Evaluation:    The critical care acquired pressure ulcers of 2008, 2009 and 2010 (post pressure ulcer prevention program) will be compared. The various unit acquired pressure ulcer goals will be compared.  The critical care nurses realized the impact of pressure ulcer prevention in just five months as they witnessed the number of days between unit acquired pressure ulcers increase from seven to 42 days.        

Implications for Practice:   Historical problems will be eliminated by examining the problem from a new perspective like Roger’s Diffusion of Innovation Theory.  Application of this theory will offer a new approach to changing nurses understanding and clinical practice.