Identifying the patient at Ultra High Risk for development of Pressure Ulcers

Purpose:
Identification of patients at Ultra High Risk of development of pressure ulcers utilizing additional screening criteria beyond the Braden score.

Significance:
The importance surrounding pressure ulcer prevention was heightened following the release of the October 2008 CMS Guidelines regarding reimbursement for “never-events” including stage III and IV pressure ulcers as well as Ascension Health's goal of zero preventable pressure ulcers.

Strategy and Implementation:
When two Stage IV pressure ulcers developed in the Critical Care Units at Brackenridge, a team comprised of nurses (including managers, directors, educators, and certified wound/ostomy/continence nurses), a physician, physical therapists, and a dietician convened to identify conditions outside of the Braden score that would predispose a patient to Ultra High Risk of pressure ulcer development. Following literature searches for available research on pressure ulcer development, along with applicable nutrition and physical therapy research, eight conditions were ultimately identified for inclusion in the Ultra High Risk Protocol. The presence of any two or more of these conditions triggers additional interventions by the bedside staff and WOCNs to provide early prevention. Every patient is screened with the Braden score and the Ultra High Risk criteria every day by the bedside nursing staff.

Evaluation:
The Ultra High Risk Protocol has been in place for almost two months and with our quarterly Prevalence Survey in mid-June, the Brackenridge Critical Care Units had no pressure ulcers noted. The daily incident data in currently not as reliable as prevalence data.

Implications for Practice:
These criteria may ultimately demonstrate as an added tool in identifying critically ill patients with Ultra High Risk of pressure ulcer development allowing for better screening and earlier intervention and implementation of prevention measures.