Pressure Ulcer Prevention is Critical: How a Surgical ICU was Successful in Decreasing Pressure Ulcers

Purpose:

To demonstrate how a comprehensive yet simple approach to preventing pressure ulcers in the ICU setting can be successful  and result in a great story of teamwork.

Problem:

How can we have an impact on pressure ulcers (PU) in a challenging surgical ICU where our in-house PU rate has been unacceptably high.

Discovery:

Literature searches were done and reviewed

Chart reviews for all patients who developed skin breakdown in the ICU revealed several types of patients that were at increased risk: multiple surgery patients, Cardiac surgery patients, thoracic surgery patients and those that were in the ICU longer than 3 days.

QI exercises were completed with the entire team including frontline staff and we found:

No mechanism to track when a patient is turned, and no one owns the process.

Lack of equipment to turn and reposition patients

Performance of skin assessment and off loading differs among staff

Strategy and Implementation:

Prophylactic dressings applied in the OR for cardiac and thoracic cases

All patients who are in the ICU for 3 days or more receive a wound consult and a low air alternating pressure mattress

Training done on how to properly turn and reposition patients.

When a surgical patient is admitted  the skin is checked at this time.  Also, the mobility and activity sections of the braden scale are completed and if the patient is at risk, a clock is hung outside the room to signify that this patient will be part of the turning program.

During report, two nurses check their patient’s skin together and turn the patient: this is called “1st turn”

After the “1st turn” the certified nursing assistants do all the turning as a team. 

Daily rounding in the ICU includes PU prevention

Results:

Decrease from 8% to 1.5%.