A Collaborative Quality Improvement Initiative Focusing on High Risk Left Ventricular Device Patients

Background: The Heart Center began implanting a ventricular assist device (VAD) in January 2012 upon receiving certification from the Joint Commission.  VAD’s are used for very high risk end stage heart failure patients. This includes either short or long term use depending on the heart condition to improve blood flow and organ function. An intra-aortic balloon pump is used temporarily to maintain heart function. These two procedures, along with the patient’s hemodynamic status and co-morbidities, place the patient at unprecedented risk for sacral pressure ulcers due to the combined forces of pressure, sheer and moisture. This occurs despite preventative measures.

Purpose:  The clinical aspects of VAD studies have not included skin impairment in patient outcomes. Current recommended prevention strategies do not prevent pressure ulcers in this subset of end stage heart failure patients with complex co-morbidities. A multidisciplinary approach for prevention is needed to decrease pressure ulcers for this specific patient population (the VAD patient).

Methods: In addition to our present prevention protocol, we implemented a multidisciplinary team consisting of the cardiac team, nurses, nutrition, rehab, surgery and the WOCN to reduce pressure ulcers in this specific high risk population:

VAD prevention protocol implemented upon admission:

1. Placement of a soft silicone bordered foam dressing to the sacrum
2. Placement on a low air loss support surface
3. Consult with WOCN
4. Follow up assessment by wound team M-W-F
5. Nutrition consult
6. Rehab consult

Conclusion: We collected data on the first 14 VAD patients.  A sacral pressure ulcer developed on two of the of the first four VAD patients for a nosocomial rate of 50%. Once we identified the risk, we implemented the VAD protocol. This resulted in no further pressure ulcers to the sacral area on the last ten VAD patients, decreasing the overall nosocomial rate to 14.2%.