Using Nurse Champions to Decrease Hospital Acquired Pressure Ulcers in the ICU

Purpose:
Quarterly prevalence studies in December 2008 revealed that there was a high rate of facility acquired pressure ulcers occurring in the Medical Intensive Care Unit (MICU). Our goal was to implement a team of nurse champions to decrease the facility acquired pressure ulcers in the MICU.

Significance:
Critically ill patients are at increased risk of developing pressure ulcers due to their acute medical condition, impaired nutrition, and prolonged immobility. Decreasing the rate of facility acquired pressure ulcers is consistent with the organization's goal of providing quality patient care.

Strategy and Implementation:
Skin champions were chosen from each of the 3 units that comprise the MICU. Each team member expressed an interest in being part of the team to bring about change in skin care within the MICU. The team was under the direction of the unit educator, with assistance, input, and consultation from the WOCN. The skin champions are responsible for weekly skin assessments on all patients, ensuring appropriate nutrition is started in a timely fashion, use of appropriate treatment and support surfaces, and consultation with WOCN when needed. Tracking of facility acquired pressure ulcers is done through quarterly prevalence studies and biannual incidence studies.

Evaluation:
Prevalence rates for facility acquired pressure ulcers in the MICU have decreased from 36.84%in the 4th quarter of 2008 to 12.5% for the 4th quarter of 2009. Additionally there has not been a stage III or IV pressure ulcer develop in the MICU within the last 6 months.

Implications for Practice:
Skin Care Champion Teams are easily adapted throughout the hospital. A quality issue was identified; a dedicated team of nurses owned the problem; a systematic plan was developed and implemented. The quantitative results demonstrate the success of this innovation.