A Multi-Phase Study Aimed at Reducing Device-Related Hospital Acquired Pressure Ulcers in ICU Patients

Purpose: To determine if a brief one-on-one educational program provided to staff nurses would decrease the incidence of device-related hospital-acquired pressure ulcers (HAPU) in the ICU.  To identify barriers and facilitators in following a hospital initiated pressure ulcer prevention “APPLE-Plus” protocol.

Background: Very little research has been conducted on the prevention of device-related pressure ulcers, particularly on the head and face. Quarterly pressure ulcer prevalence studies at our urban acute care hospital/ Level 1 Trauma Center revealed an increasing number of device-related HAPU on the head and neck, with most occurring in CVICU and ICU.

Method: A descriptive quasi-experimental intervention study was implemented.  Three advanced practice nurses (APNs) rounded in ICU for 2 day shifts/week and 1 night shift/week for one month.   APNs reviewed the APPLE-Plus protocol with each ICU nurse. The  APPLE-Plus mnemonic is:  Assess ears when initiating oxygen, Protect ears from friction, Pad tubing with foam, Loosen tubing , Educate and Evaluate.  Plus focuses on devices common in the ICU.  Plus head/ neck assessment, Lips - assess ET tube, Under masks, trach collars & ties, and immobilizers, Suction devices and NG tube tape.

Next, an anonymous three question semi-structured qualitative survey was administered to each ICU nurse.  Questions were aimed at identifying facilitators and barriers to implementation of the APPLE-Plus protocol in the ICU.

Results: There were no (zero) device-related HAPU in the ICU during the quarterly prevalence study conducted in the month following the study intervention. RN survey responses are being analyzed using descriptive statistics of percentages and frequency distribution.

Conclusion: Brief, focused education is effective in increasing HAPU prevention interventions in ICU.  Survey response data will be used to plan Phase II study to guide practice changes in the prevention of HAPU.