Controlling Things We Can to Prevent HAPU's/SDTI's

Controlling Things We Can to Prevent HAPU’s/SDTI’s

Background:  In 2008, The Center of Medicare and Medicaid Services stopped reimbursing for Stage III and IV hospital acquired pressure ulcers (HAPU’s).   In 2010, our facility had total of six HAPU’s. Three of these HAPU’s were suspected deep tissue injuries (SDTI’s) on patients following cardiovascular surgeries.

Problem:

Literature related to HAPU/SDTI prevention in the OR and the critically ill patient population is lacking. One HAPU can cost up to $ 40,000, increase length of stay, and potential for mortality.

Objective:  

• Decrease SDTI’s in Critical Care Unit (CCU), Intensive Care Unit (ICU), Cardiovascular Intensive Care Unit (CVICU) and the Cardiovascular Operating Room (CVOR) population.
• Initiate a prevention protocol to address friction, shear, and manage microclimate.
• Decrease hospital costs through reduction of HAPU/SDTI’s with the application of a soft silicone sacral dressing (SSSD).

Setting: The CCU, ICU, CVICU and CVOR.

Participants:  CCU, ICU, CVICU patients meeting Bridle’s² inclusion criteria. CVOR patients with surgeries ≥ 4 hours.  

Method:  SSSD was applied to the sacrum, skin assessed daily, and dressing changed every 3 days.

Results:  58 enrolled in the study, 56 completed with a 0% incidence of HAPU/SDTI’s.    Two patients were dropped from the study because protocol was not followed.

Conclusion: The use of the SSSD, as part of a comprehensive Pressure Ulcer Prevention Program, played an integral part in the reduction of HAPU/SDTI’s by reducing friction, shear and managing microclimate of high risk critically ill, cardiovascular patients, and patients undergoing lengthy cardiovascular surgeries. Although a small sample, this case study validates the study performed by Cherry³ in 2011. Our facility has adopted use of the SSSD as a “Best Practice” in the population studied.  The use of the SSSD is being evaluated for use on patient  procedures ≥ 4 hours across  all specialties.