Preventing Preventable Pressure Ulcers: A Comprehensive Approach

Purpose/Problem

Reports estimate 50% of the most dangerous pressure ulcers that occur in the acute-care setting are preventable. Pressure, friction/shear, and moisture are all contributors to preventable pressure ulcer (PPU) development.

Objective

A goal of zero PPUs was set as a measurable objective for the Intensive Care Unit (ICU).  Prevention interventions, addressing all causative agents of pressure ulcer development, needed to be implemented and utilized by bedside staff to achieve this goal.

Outcomes

The goal of zero PPUs was achieved with consecutive preventative interventions implemented.  In 2008, the ICU mattresses were replaced with low air loss and pressure relieving mattresses.  In 2009, protective barrier cream was implemented to keep excessive moisture away from the patients’ skin.  With those two new interventions, 5 PPUs were still seen in quarter one of 2010.  In quarter one of 2011, ceiling lifts were added to each bed in the ICU to decrease the friction and sheer associated with repositioning patients.  Quarter two of 2011 saw only 4 PPUs.  In quarter 3 of 2011 airflow pads replaced cloth pads, to better protect patients’ skin from excessive moisture and incontinence associated dermatitis.  With this intervention only 1 PPU was seen in quarter 4 of 2011.  Finally, with the addition of continuous bedside pressure mapping in Q4 2011, the goal of zero PPUs was achieved in Q1 & sustained in Q2 2012.

Conclusions

With a comprehensive approach to addressing all causative agents in pressure ulcer development, moisture, friction/shear, and pressure, a goal of zero PPUs is achievable.