GS14-004 Universal Pressure Ulcer Prevention Bundle with WOC nurse support

Sunday, June 22, 2014: 2:00 PM
Megan Anderson, RN, BSN, CWOCN, CFCN1, Patricia Finch Guthrie, PhD, RN, CNS2, Patricia Reicks, RN, BSN, CCRN, CNRN3, Wendy D. Kraft, RN, BSN, CWOCN1 and Carol Skay, PhD4, (1)North Memorial Wound, Ostomy, and Continence Nursing Service, North Memorial Medical Center, Robbinsdale, MN, (2)Department of Interprofessional Education, St. Catherine University, St. Paul, MN, (3)North Memorial Trauma Services, North Memorial Medical Center, Robbinsdale, MN, (4)Independent Consultant, Wayzata, MN
Background:   Incidence of pressure ulcers in critical care can range from 14 to 42%. Nurses’ lack of knowledge, delays in Wound Ostomy Continence (WOC) nursing consults, combined with inconsistent guideline adherence are major factors. Pre-study, critical care nurses in a mid-west hospital used a guideline with 31 interventions and WOC nurse referrals for high-risk patients. This study tested a pressure ulcer bundle (UPUPB) with five evidence-based interventions applied universally to critical care patients combined with proactive WOC nurse rounding.
Purpose:  Study aims included comparing the UPUPB and rounding to the original guideline regarding nurse adherence to five prevention interventions and pressure ulcer incidence. 
Methodology:  A quasi-experimental design was used with 181 patients in the pre and 146 in post intervention phases who met criteria of ≥ 18 years of age, no admission pressure ulcers, and admitted to critical care for >24 hours. Data collection included admission/discharge skin assessments, chart reviews for interventions and patient characteristics, and rounding logs.  Analysis included description of rounds, t-test for guideline adherence, and multivariate analysis for intervention effectiveness on pressure ulcer incidence. Unit assignment, Braden score, and critical care length of stay were covariates for the multivariate model based on bivariate logistic regression screening.
Results:  Pressure ulcer incidence decreased from 15.5% to 2.1%. WOC nurses logged 204 rounds over 6-months, focusing on pressure sources. Adherence increased for heel elevation (t = -3.905, df 325, p<.001) and turning (t = -2.441, df 325, p<0.015). Multivariate logistic regression modeling, adjusted for covariates, showed a significant reduction in pressure ulcers for the intervention (Wald =17.879, df 1, p<.001). The intervention increased the Nagelkerke R-Square value by .099 (p<.001) above .297 (p<.001) when including only covariates, for a final model value of .396 (p<.001).
Conclusion: The UPUPB with rounds played a highly significant role in reducing pressure ulcers.