To Infinity and Beyond: Keys to Prevent Pressure Ulcers in Critically Ill Patients

To Infinity and Beyond:  Keys to Prevent Pressure Ulcers in Critically Ill Patients.

            Increasing financial burdens in our healthcare systems have led to streamlining costs and optimizing preventative practices.  Research studies consistently reveal that pressure ulcers remain a major focus in patient care. Our Intensive Care Unit (ICU) wanted to confront this problem head-on and significantly reduce the number of pressure ulcers.  Our goal was to form a focus group and search the literature to determine if our current scale was sufficient in identifying the risk of hospital acquired pressure ulcers in our critically ill patients.  The review suggested that our current scale might have limitations in determining risk factors for our patient population, so a scoring system was created from the unit-based council to target the patients at highest risk for acquiring pressure ulcers.  The scoring system contains criteria specific to ICU patients in relation to  ventilator support, vasopressor use, nutrition, dialysis, and high oxygen need just to name a few.  Specific nursing interventions and barriers to implementation were  discussed and shared at the unit level, and strategies for both bedside nurses and their leaders in the development of a plan to reduce pressure ulcers was formulated. The Skin Resource Tool was initiated in July of 2014 with specific criteria for pressure ulcer prevention.  Categories include:  standard interventions, high risk interventions (based on the scoring system), respiratory therapy interventions, barrier creams, device related checks and tough situation principles.  With the use of the scoring system and the skin resource tool coupled with education of all staff and the interdisciplinary team, our unit significantly reduced unit-acquired pressure ulcers.  From January – July of 2014, the average ICU pressure ulcer rate was 2-5 per month.  From July – December 2014, the ICU has had ZERO hospital acquired pressure ulcers.