Turning up the HEAT: A Multidisciplinary Approach to Best Practice Pressure Ulcer Prevention in the Burn Unit

Care of the burn patient is complex and requires a multidisciplinary approach. Patients in this population are at risk for systemic complications such as edema and infection. Critically ill burn patients at high risk often cannot escape hospital acquired pressure ulcers. Beyond physical needs of the patient, the multidisciplinary burn care team is aware of the psychological impact of acute injury, phases of recovery and long term rehabilitation needs of the burn patient. 

The State of Pennsylvania Hospital Engagement Network along with our Healthsystem Patient Safety & Quality established a goal of reducing hospital acquired pressure ulcers by 20%.  A 6 month trend of hospital acquired pressure ulcer incidence sparked an interest by the Wound, Ostomy, Continence Nurse to determine the underlying risk factors related to HAPU’s in the burn unit, where meticulous care is provided to heal acute burn injury. A retrospective chart review resulted in identification of predominant risk factors placing the burn patient at high risk for pressure ulcer formation. Implementations of pressure ulcer prevention measures were inconsistent.  Nurses demonstrated varied levels of knowledge about products used for prevention.  It became imperative to examine processes within the unit, provide nursing with necessary education, access to skin care supplies and advanced skin/wound care products for maintaining skin integrity. Creation of evidence based guidelines was necessary to improve patient outcomes.

A collaborative team approach to increase nursing & physician awareness of pressure ulcer risk, and developing evidence based prevention guidelines with early intervention was achieved. Nursing education on current products in formulary, availability of high end support surfaces and positioning devices engaged the staff in prevention of avoidable pressure ulcers. A change in practice and positive trend in pressure ulcer incidence data supports the success of our program.