What Factors Are Associated With the Development of Pressure Ulcers in a Medical Intensive Care Unit?

Purpose:
Patients in the intensive care unit are at a high risk for skin breakdown and development of pressure ulcers. Tools used to determine the risk of pressure ulcer development are universally applied to adult patients. These tools do not differentiate between intensive care and acute care patients.

Background/Significance:
Stage 3, 4, and un-stageable pressure ulcers are Joint Commission Never Events. Pressure ulcers contribute to negative outcomes such as a decrease in quality of life, an increase in pain and discomfort, greater potential for infection, and increased hospital stay and costs. Intensive care unit clinicians in all hospital settings use risk assessment tools to predict pressure ulcer development. Appropriately pin-pointing the risk factors are paramount to implementing a targeted care plan.

Methods:
Clinicians completed a 15-month retrospective review of pressure ulcers in a medical intensive care unit in a university-affiliated academic hospital. Descriptive statistics and correlations were computed on pressure ulcer stage, gender, age, weight, Braden scores, hemodynamic support, oxygen requirement, comorbidities, admitting diagnosis, discharged status and length of stay. The hypothesis was that key factors would be identified.

Results:
The characteristics of 76 patients who developed pressure ulcers were evaluated. Thirty three men and 29 women were included. The majority (48.6%) suffered a stage II pressure ulcer. The presence of hemodynamic support through vasopressor use was noted as the most significant factor in pressure ulcer development (p=0.006).

Conclusions and Implications for Practice:
Hemodynamic support is not a factor in current pressure ulcer risk assessment tools. The prevention of pressure ulcers begins with appropriate identification of those at risk. Tools incorporating hemodynamic support are needed.