Multifaceted Approach to Decreasing Pressure Ulcers in the ICU

Purpose:
A multifaceted approach was implemented to decrease pressure ulcers in the Intensive Care units to at or below NDNQI benchmarks.

Significance:
Pressure ulcer prevention has been a goal, yet a challenge in the Intensive Care environment. To decrease the incidence of hospital acquired pressure ulcers, a four pronged approach was implemented which addressed routine rounding, specialty beduse, bed surface assessment and staff education.

Strategy and Implementation:
The incidence of pressure ulcers in the intensive care units rose sharply in 3Q07 related to a number of highly susceptible patients. As a result of the data spike, the Skin Care Team reviewed cases and contributing factors. A number of initiatives were embarked on to lower the prevalence of hospital acquired pressure ulcers in the ICUs. An analysis of the bed surfaces was completed and replacement mattresses recommended. The indications for and use of specialty beds was re-evaluated and practice changed. Routine rounds to include skin assessment were implemented, reinforcing early and complete assessment. Staff education occurred in two initiatives, the first focused on appropriate products, Braden scale, bed use and documentation. The second, a grand rounds format, focused on early assessment, detailed differentiated staging exercises and early interventions. Individual coaching and feedback followed. To maintain vigilance, data was reviewed monthly by the Practice Council.

Evaluation:
Wishard Health Services participates in the quarterly NDNQI prevalence study, but increased the frequency to monthly. From the highest incidence of 40% in 3Q07 Hospital Acquired pressure ulcers has decreased to at or below benchmark since 2Q08 in the Intensive Care Units.

Implications for Practice:
Multiple factors contribute to hospital acquired pressure ulcers. By addressing identified issues simultaneously, measurable progress toward pressure ulcer prevention is achieved.