Preventing Pressure Ulcers: Things Aren't What They Seem

Purpose:
Trauma patients typically have intact skin. However, due to complexities of caring for trauma patients the risk factors and strategies to prevent pressure ulcers are different than for non-trauma patients. The goal was to identify effective strategies for trauma patients.

Significance:
Review of ICU patient data revealed ulcers were not sacral wounds, but facial, occipital, elbow, and heel wounds. Traditional efforts focused on sacral wounds. A nurse-driven protocol to prevent pressure ulcers in trauma patients was implemented by recognizing differences in patient populations.

Strategy and Implementation:
A multidisciplinary group identified three main gaps in practice. In order to address the first gap of education, the team created wound care checklists with instructions. Unit bulletin boards were updated with literature related to non-sacral sites for PU development, which was novel from the previous approaches. The second gap of medical equipment was addressed by partnering with the wound care nurse. An adaptation to the endotracheal tube holder and cervical collars were made to avoid unnecessary pressure on the patient head and face. Lastly, the third gap was addressed by ensuring consistent practices on all shifts. A nurse was assigned to round and assess key pressure points. Also, purposeful hourly rounding with an emphasis on preventing PUs was implemented, further ensuring consistent nursing practice.

Evaluation:
Within one quarter the nosocomial PU rate decreased from 25% to 10%; and within two quarters the rate fell to zero, results far below the Magnet mean of the NDNQI database.

Implications for Practice:
Pressures ulcers (PU) increase morbidity, mortality, increase length of stay, and may go unreimbursed. Project results demonstrate that with focused attention on the type and location of ulcers, specific intervention strategies can be successful in improving patient outcomes in the ICU setting.