Reducing Pressure Ulcer Prevalence in the ICU: An Evidence Based Practice Change

Purpose:
The pressure ulcer prevalence rates in the ICU were consistently elevated above the national benchmark set by NDNQI. The purpose of this evidence-based practice (EBP) strategy was to reduce unit-acquired pressure ulcers in the ICU to either meet or exceed the NDNQI benchmark.

Significance:
Pressure ulcers are a challenge for healthcare institutions across the nation. Pressure ulcers negatively impact patient and family satisfaction, nursing satisfaction, and the financial health of an organization.

Strategy and Implementation:
A multidisciplinary task force which included ICU nurses, the wound care nurse, nutrition and a physician was developed. With support from administration, the team developed an evidence based nursing strategy to reduce pressure ulcers (PU) in the ICU. The innovation included a PU prevention guideline that was developed based on recommendations from the NPUAP and AHRQ, as well as recently published research studies. The guideline included 4 key categories of interventions including documentation, risk assessment, positioning/bedding, and skin care/incontinence. An order set was also developed for high risk patients which included more advanced interventions such as wound and nutrition consults, and criteria for low air loss therapy. All staff members were educated on the EBP change and "wound warriors" were designated for each shift to assist staff nurses through the change. Weekly quality rounds were conducted to ensure staff compliance with the guideline.

Evaluation:
The EBP change was effective. Unit acquired prevalence rates submitted to NDNQI ranged from 4-10% in the previous 4 quarters prior to implementation of the EBP change. Post implementation, unit-acquired prevalence rates submitted to NDNQI were reduced to 0% in each of the following three quarters.

Implications for Practice:
The EBP change has become the standard of care in the ICU and has had a positive impact on patients throughout our organization. Pressure ulcers, which were once standard and accepted in our ICU, have literally become non-existant, and has changed the culture of our unit and made skin a priority.