Putting the Pressure on Pressure Ulcer Prevention in the Intensive Care Unit

Background: Patients in the intensive care unit (ICU) are at high risk for pressure ulcers due to complex, critical illnesses that are cared for in this setting. Regulatory changes resulting in non-payment for hospital acquired stage III and stage IV pressure ulcers and continual enhancement of quality care prompted focused pressure ulcer prevention in the six ICUs of an urban acute care facility.

Purpose: To decrease the number of hospital acquired pressure ulcers in the ICU.

Objective: (1) To assist nursing staff with individualization of interventions for pressure ulcer prevention (2) To provide the nursing staff with the resources needed for pressure ulcer prevention.

Intervention: A multi-faceted approach was taken by the WOC nursing team after review of the monthly pressure ulcer data and discussion with unit skin champions. A rounding tool was developed that utilized the Braden Scale and clinical practice issues to drill down on risk factors for pressure ulcer development. The WOC nurses, unit leadership, and skin champions rounded once weekly. This allowed real time education, discussion and intervention with the nurses on the unit. During this time, emphasis was placed on obtaining cardiac chairs and low air loss surfaces. Secondly, a mobility assist team comprised of two summer interns was initiated to assist with repositioning and early mobility. Finally, mandatory in-services were provided to all ICU staff regarding pressure ulcer prevention related to medical devices, incontinence, and immobility.

Outcome:  In June 2012, 14 patients out of 52 in the critical care units had a hospital acquired pressure ulcer (26.9%).  In November 2012, 5 patients out of 51 in the critical care units had a hospital acquired pressure ulcer (9.8%). Over the course of the last six months there has been increased engagement, accountability of their peers, and consults to the WOC nurse for assistance with care.