Bi-Weekly ICU Skin Rounds: Changing Nursing Practice to Prevent and Treat Hospital Acquired Pressure Ulcers (HAPUs)

Topic:

HAPUs are serious clinical complications that lead to increased hospital stay, pain, infection and potentially death. In 2007, the Centers for Medicare & Medicaid Services reported 247,412 cases of pressure ulcers as a secondary diagnosis. The mean cost for treating a pressure ulcer is $43,180. The goal of this innovative preventative practice is to decrease HAPU prevalence in the ICU.

Purpose:

The primary purpose of this preventative practice is to raise critical care nurses’ awareness of skin care and change the culture from a reactive to a proactive mindset related to the prevention and treatment of pressure ulcers. Additional goals include: promote a stronger interdisciplinary collaboration related to skin issues, increase the use of preventive measures and promote accurate pressure ulcer staging and documentation

Objective:

Data analysis revealed the ICU HAPU rate didn’t meet Magnet benchmarks facilitating an initiative on HAPU prevention and care. Utilizing a tool based on evidence based guidelines, Multidisciplinary Skin Rounds (MSR) were initiated and have been completed twice weekly since 6/25/12.  Standardization of turning documentation to right, left back every two hours on ICU flowsheet was initiated. Team member’s education focused on mattresses, wound care products and HAPU prevention and care. Emphasis on accurate documentation of the Braden Scale, skin condition and HAPU incident report filing is discussed at Skin Rounds.

Outcomes:

Baseline data from 8/11 to 7/12 revealed HAPU rate of 13.7. After the initiation of the Bi-Weekly MSR, the HAPU rate from 8/12-7/13 was 8.6. Multidisciplinary members endorse greater collaboration during MSR, plus a heightened awareness for HAPU prevention and care. Clinical Manager has noticed an increase in HAPU reporting.  Sustaining continued success will be facilitated by continuing MSR which fosters “in the moment” educational opportunities and promoting a collaborative approach to HAPU prevention and care with emphasis on accurate wound documentation.