A Quality Initiative: Standarizing the support surface in the critically ill population to reduce hospital acquired pressure ulcers

INTRODUCTION: Hospital acquired pressure ulcers (HAPU) are a serious adverse event and impact upon resources and patients quality of life. The developments of HAPUs are associated with increased comorbidities, decreased quality of life, longer length of stay in the hospital, and financial burden. Critically ill patients are at greater risk for HAPU development due to their impaired physiologic status and prolonged periods of immobility. Evidence-based HAPU prevention requires multiple interventions and clinical team collaboration. Pressure redistributing support surfaces are one of the interventions necessary for HAPU prevention in the critically ill patient population.                                                                                                                                                                                                                                            METHODS: This quality improvement (QI) intervention took place on a 26-bed Intensive Care Unit (3 pods: medical; cardiac; trauma). The metrics utilized for the study included HAPU incidence per 1000 patient days for a period 10months prior and 10 months after. The QI intervention consisted of selection and purchase of new beds for the 26-bed ICU, in addition to caregiver education on appropriate use of the beds. The facility’s HAPU prevention bundle was continued as part of the standard of care. Standardization of bed technology utilization was the main focus of this QI initiative, ensuring standardization of technology and reduced confusion amongst clinical caregivers on appropriate use of the bed in relation to HAPU prevention through pressure redistribution, offloading, and repositioning.
RESULTS: 10 months prior to the utilization of the new pressure redistribution mattresses, there were 13 HAPU’s. 10 months after the initiation of the new mattresses 3 HAPU’s developed.                          DISCUSSION: Standardization of bed technology may have contributed to reduction in HAPUs, and helped ensure evidence-based best practices were provided at the patient’s bedside.