Real-Time Visual Pressure Assessment and Monitoring in Intensive and Critical Care to assist with Pressure Injury Prevention

Jesse Robles, RN BSN CCRN, Critical Care- ICU/DOU, VA San Diego Healthcare System, San Diego, CA and Heather Bivens, MSN RN ACNS-BC, Critical Care- DOU, VA San Diego Healthcare System, San Diego, CA

Patients admitted to critical care units (CCU) in hospitals are more susceptible to developing hospital acquired pressure injuries (HAPIs).  Despite advances in specialty beds, mattresses, and prevention bundles, patients are still developing HAPIs in CCUs due to their severe illness and comorbidities.  A key part of pressure injury prevention is repositioning, however off-loading pressure areas is difficult to assess without a diagnostic tool.  Additionally, studies have shown that current repositioning practices fail to offload areas completely, which may contribute to HAPIs.  Evidence confirms the effectiveness of using a real-time pressure monitor (RTPM) to offload high pressure areas effectively, serving as a visual guide to decrease skin interface pressures with assurance. 


RTPMs were placed on existing mattresses in the Intensive Care Unit/Direct Observation Unit.  Healthcare providers (HCPs) utilized the RTPMs to manage interface pressures.  A historical comparison group of the same units had only the pressure ulcer prevention bundle with the mattress. 


RTPM identified mattresses that were not being used in therapeutic mode, hence not to maximum benefit.  Many mattresses were exposing patients to very high pressures.  HCPs adjusted modes on the mattresses to provide therapeutic pressure redistribution.  HCPs were also able to adjust the air in the mattresses to find better pressure redistribution for individual patients.  Peak pressures were identified and interventions were taken to lower these high pressures with assurance using the RTPM color image.  The RTPM group developed 2 HAPIs over 3 months, whereas 5 developed when RTPM was not used.


RTPM provided visual assessment and monitoring of interface pressures allowing HCPs to maximize the use of existing mattresses and reposition patients with enhanced pressure redistributions.  RTPM assured existing mattresses were being utilized to maximum therapeutic benefit.  HAPIs decreased with the use of the RTPM.