Utilization of a Skin Care Bundle to Decrease Pressure Ulcers in the Critical Care Unit

Purpose:
The Skin Care Bundle was created to decrease occurrence of unit acquired pressure ulcers with recognition of patients at risk for pressure ulcer development and implementation of strategies for prevention.

Relevance/Significance:
Pressure ulcer-related hospitalizations increased by 80% from 1993-2006 (Sendelbach 2011). Institute for Healthcare Improvement (IHI) found strong evidence on implementation of proven best practices to radically reduce pressure ulcers in hospitals (IHI, 2011). The Skin Care Bundle is created to prevent pressure ulcer development by integrating evidence-based practice into nursing practice. Its implementation requires collaboration among interprofessional groups to provide patient centered care.

Strategy and Implementation:
Critical Care Unit Based Shared Governance Council identified an opportunity to address the increase in unit acquired pressure ulcers with a specially designed team. The team consisted of resource nurses for each shift. This led to the development of "skin care champions". Skin Care Champions participated in an interprofessional education program and literature review led by the Certified WOC Nurse, a physical therapist/clinical wound specialist and a clinical dietitian. Electronic documentation was created through collaboration of clinical dietitian, Skin Care Champion, and Information Technology. The team has developed many innovative ways to keep the focus on the new process. Stickers, candy rewards, frequent e-mails and posting of data are a few of the methods Skin Care Champions and Shared Governance Leadership utilize to communicate about the Bundle. Monthly pressure ulcer surveys have confirmed a significant decrease in unit acquired pressure ulcers since initiating the Bundle.

Evaluation:
Skin Care Bundle now serves as a foundation for pressure ulcer prevention. Outcomes in Critical Care for unit acquired pressure ulcers revealed a decrease in rate of 78% from 4th Quarter 2013 to 4th Quarter 2014. The Skin Care Bundle has been introduced throughout the hospital to ensure improvement in pressure ulcer prevention. Clinical Nurses have adopted the Bundle into their daily practice.

Implications for Practice:
Awareness of the impact of pressure ulcers warrants the implementation of best practice (Stephen-Hayes 2011). Outcomes for Skin Care Bundle have demonstrated a best practice in our organization. As with any change, stabilization of this new practice is necessary to achieve continuous improvement.