Critical Care Mastery and Autonomy: The Effect of a Focused Intervention on a Pressure Ulcer Prevention Program in the ICU

Critical Care Mastery and Autonomy: The Effect of a Focused Intervention on a Pressure Ulcer Prevention Program in the IC

Purpose/Objective

The purpose of this performance improvement project was to evaluate the effectiveness of a shift-to-shift skin assessment protocol added to the existing bedside rounding conducted during shift change in a high acuity ICU at a large local community hospital.

Background/Significance

Hospital acquired pressure ulcers can significantly impact patient length of stay and mortality. In an era of value-based purchasing, hospital-acquired pressure ulcers can lead to substantial loss of reimbursement. From a holistic nursing perspective, pressure ulcers can be painful and debilitating, contributing to psychological and emotional distress that impacts quality of life and healing.

Methodology/Data analysis

Focused skin assessments including all potential pressure areas were added to the bedside rounding at shift change. Documentation of skin assessment was included in the shift change note by the oncoming RN, and monitored by unit leadership. Unit metrics were collected by the designated unit wound care RN and hospital wound care team.

Findings/Implications

To date, a 33% reduction in actual incidence of pressure ulcers combined with a 30% increase in units of service has dramatically reduced our pressure ulcer rate. Focused skin assessment enabled the nurses to intervene before breakdown occurred, and also identified new potential sources of skin breakdown from artificial airway securement devices and positive airway pressure masks.

Discussion

Enhanced shift-to-shift bedside rounding with skin assessment has reduced the incidence of pressure ulcers in the ICU. The intervention is now woven into the patient/family centered care narrative that supports patient safety and comfort during the patient stay in the ICU. Unit nurses are empowered to consult wound care and order specialty beds and other protective products as needed as part of their continuing vigilance for pressure ulcer prevention.