Suspected Deep Tissue Injury Prevention: A Bed Algorithm

Suspected Deep Tissue Injury Prevention: A Bed Algorithm

The purpose of this project was to identify patients at risk for developing a Suspected Deep Tissue Injury (SDTI) using evidenced-based research on pathology of SDTI and causal trends as criteria in creating a bed algorithm to prevent SDTI. 

  The mattress that was chosen for treatment and prevention was a low air loss therapy mattress providing the equivalent of 1740 liters of air per minute for all patients towards reducing SDTI incidence. The mattress rental needed to withstand 600 pounds and be durably constructed to promote safe patient handling.

 With the rise in obesity, our patients in the acute care setting have increased co-morbidities and have many of the “risk factors” for pressure ulcer development: impaired activity or mobility, impaired nutrition, poor perfusion and oxygenation, increased skin moisture, advanced age, increased shear, poor sensory perception and poor general health status.

 The objective of this project was to create a unit-based bed algorithm for proper support surface for ICU, MST, BHS and ED patients with Braden 18 or less and decreased mobility with evidence of pressure ulcer or history of pressure ulcers, patient found down prior to admission, ventilator support greater than 24 hours, Vasopressor use greater than 24 hours, duration of surgery greater than 3 hours, excessive moisture, bariatric, presence of burns, flaps or grafts, and intractable pain.

 The project was conducted in a Level 3 Trauma 86 bed acute care hospital in Tucson, AZ.  Historical rates of incidence of SDTI were 8-13%. “Consulting” the unit-based bed algorithm was included in the Pressure Ulcer Prevention (PUP) Protocol. Education was delivered to staff on PUP form revisions. The efficacy of the bed algorithm was determined in the next prevalence study and a rate of zero hospital-acquired pressure ulcers was found and has remained for 2 years.