Preventing Pressure Ulcers in ICU: A Performance Improvement Project

Rita Whitney, CWOCN, Wound/Ostomy, Medical Center of Lewisville, Lewisville, TX


In the 8-bed ICU at Medical Center of Lewisville, Hospital-acquired pressure ulcers (HAPU’s) are lower than benchmarks but were still occurring at higher rate than other units.

Clinical Question/Practice Problem/Type of Study

This was a Performance/Quality Improvement project.  PICO question: In ICU patients, does the use of a sacral foam dressing decrease the number of HAPU’s on the sacrum?


Problem was identified through quarterly pressure ulcer prevalence surveys and ongoing surveillance of data.  Worked with Critical Care PPC, instituted new intervention of applying silicone sacral dressing to all ICU patients in 8 bed general ICU.  Data was collected using a retrospective review.


In the two year period prior to intervention, the ICU had HAPU’s on the sacrococcyx as follows: 11 DTI’s, 5 Stage II’s.  In the two year period following the intervention, the ICU has had HAPU’s on the sacrococcyx: 5 DTI’s, 4 Stage II’s.  This showed more than a 50% improvement in the number of DTI’s to the sacrococcyx, as well as a reduction in the number of Stage II HAPU’s.


Although not a controlled study, the results were significant.  Since no other new interventions were implemented during this time period (no change in support surfaces, skin care products, incontinence pads, repositioning protocols, etc.), we concluded that the prophylactic use of a soft silicone bordered sacral foam dressing decreased sacral HAPU’s in the ICU.

Lessons Learned/Recommendations

In view of the positive results and nursing staff feedback, we have extended the use of prophylactic sacral foam dressings to high risk patients on all inpatient adult nursing units.