Grooming your Pressure Ulcer Prevention Program (PUPP): Sustainability and Better Patient Outcomes in the Intensive Care Setting

Purpose: Drill down on assessments, moisture, compliance, resources, and empowering staff to reduce hospital acquired buttock and sacral pressure ulcers (HAPU) in a 12 bed intensive care unit. Objective/Significance: Critical care patients are at higher risk for developing HAPU because of hemodynamic instability, comorbidities, devices, and vasopressors. Bundling evidence based practices (EBP) has shown to improve patient outcomes.  Gaps existed with bundling and charting. Problems with moisture, shear, and friction continued. Objective was to develop a strategy to sustain a bundled EBP and reduce overall HAPU by 25% for the year and zero buttocks and sacral HAPU for 30 days. Strategy/Implementation:  Current resources: 5 layer silicone sacral adhesive foam, lift team, heel suspension boots, barrier cloths and creams. New resources: 30 day trial of absorbent under pads; eliminated blue quilted under pads, diapers, and chux; emphasis on barrier cloths and foam cleanser instead of washcloths and liquid soap. Wound care nurse: development of a bundled checklist; 1:1 return demonstration education for risk assessment and charting; chart audits; compliance graphs; safety calendar, bi-weekly rounding. Practice changes: risk assessment every shift and dual registered nurse skin assessments at admission and transfer. Education: product representatives and lift team refresher course. Results: No hospital acquired shear, friction, dermatitis, or pressure ulcer development in 74 patients. The skin champions and staff became the gatekeepers for the PUPP. After 1 year, we saw a HAPU reduction of 67% and compliance averaged 95%. Conclusion: We extended the practice in the hospital with additional resources: ear protectors, chair cushions, absorbent pull-ups, skin champions, education added to orientation, and purchased a low air loss with microclimate management surface.  With a customized EBP checklist and buy in from staff, education, increased compliance, and additional resources to bundle our approach; we were able to decrease our HAPU by 57% hospital wide.