Decreasing ICU Pressure Ulcer Incidence With Risk Focused Prevention Rounds

Purpose:
Pressure ulcer prevalence and incidence rates are high in the adult critical care population. The purpose of this project was to determine if clinical skin rounding would positively impact implementation of prevention interventions and pressure ulcer incidence in adult intensive care units (ICUs).

Significance:
Pressure ulcers are a health problem which can result in prolonged length of stay, increased pain and suffering, and increased health care costs. Pressure ulcers are one of the NDNQI Nursing Sensitive Indicators with the quality of nursing care having direct impact on pressure ulcer incidence.

Strategy and Implementation:
An ICU pressure ulcer prevention team was formed incorporating clinical leadership from five adult ICUs and consultants from the wound ostomy team and School of Nursing. Using the Braden Risk Assessment tool and current literature on evidence-based nursing interventions, a risk focused pressure ulcer rounding tool was developed. This tool is utilized by clinical leadership, including clinical nurse specialists, managers, and supervisors to conduct daily skin rounds on patients in the ICU. The tool allows clinical leaders to track patients' risk for pressure ulcer development, and current skin status. It also enables leadership to ensure that interventions implemented are both comprehensive and appropriate. During rounds, leadership reinforce the importance of skin care and pressure ulcer prevention interventions providing “real time” teaching and knowledge reinforcement to nursing staff.

Evaluation:
Implementation of daily skin rounds resulted in improved unit acquired pressure ulcer incidence in all of the involved units, with some units reaching zero. Elapsed time between education and implementation of nursing interventions also decreased after daily rounding was introduced.

Implications for Practice:
Risk focused pressure ulcer rounds facilitate timely implementation of appropriate prevention interventions, positively impacting patient care and unit incidence. Engaging clinical leadership in these rounds reinforces the value of nursing intervention and emphasizes skin care as a priority.