Acting Boldly to Reduce Pressure Ulcers in the Cardiothoracic ICU

Purpose:   Pressure ulcers are a risk in our cardiothoracic ICU (CT-ICU) patients. They are one nurse-sensitive indicator reported to the National Database of Nursing Quality Indicators. In early 2011, pressure ulcer prevalence was a persistent problem at over 20% in spite of concerted efforts to reduce them.

Objective:  Implement a multi-strategy approach to reduce pressure ulcers to reduce our prevalence below 4% and sustain the achievement.                                                                           

Description:   Our CT-ICU pressure ulcer reduction team conferred with a performance improvement specialist, a certified wound/ostomy nurse, and the hospital’s Pressure Ulcer Preventable Harm Team.  We searched the literature, including the resources of the National Pressure Ulcer Advisory Panel to develop our structured performance improvement process. Multiple factors thought to cause pressure ulcers led us to try multiple interventions until we found the right combination. These interventions included: nursing and medical leadership involvement;  emphasis on bedside shift report; evaluation of pressure-ulcer therapy supplies; aggressive use of prevention tools including placement of a silicone adhesive hydrocellular foam dressing on every post-op patient; better inter-rater assessment of suspected pressure ulcers; real-time pressure ulcer identification and data tracking; pressure ulcer site care tailored to the type of problem; and, weekly posting of our unit-acquired and hospital-acquired pressure ulcer rates so that all could see the results of these efforts. Weekly evaluation of which interventions seemed to be working helped us focus changes in our strategies.                                                                                                                                                             

 Outcomes:  From January to March 2011, our average monthly unit-acquired pressure ulcer rate was above target at 22%. In Apr. 2011, trends in our data showed the change we had hoped for.  From April through September the average monthly unit-acquired pressure ulcer rate had fallen to 2.4%.  We have found a combination of strategies for our CT-ICU patients that make unit-acquired pressure ulcers a much less common event.