Preventing Pressure

Ulcers in ICU Patients

By Robinson, Jennifer, Cristina, Damary, and Jaqueline
 Statistics in the United States
 2.5 million patients are affected per year1
 Cost of $9.1-$11.6 billion per year1
 In 2007, Medicare estimated each pressure ulcer added
$43,180 to a hospital stay1
 In 2013, Medicare reported hospital-acquired pressure
ulcers to be 4.5% in hospitalized patients2
 More than 17,000 lawsuits are related to pressure ulcers
annually1
 Still et al. found occurrence of PUs in ICUs ranges from
8.8 to 23 % depending on ICU setting3
 About 60,000 patients die as a direct result of a pressure
ulcer each year1
 Proposed Change/Goals
 Decrease incidence of pressure
ulcers in patients by 4,1:
 Inspect skin daily

 Manage moisture on skin

 Conduct a pressure ulcer

admission assessment for all
patients

 Minimize pressure

 Optimize nutrition and hydration

 Reassess risk for all patients daily

 Pressure Ulcer
Causes/Factors
 Immobility5

 Moisture5

 Friction/shear5

 Poor nutrition/dehydration5

 Urine/Fecal Incontinence3

 Duration of mechanical ventilation5

 Length of stay in ICU5

 Advanced age5
 Effects on Health Care
 2007 - 257,412 reported cases of pressure ulcers 6
 October 1, 2008 – Medicare/Medicaid ceased providing
payment for certain HA conditions7

 Mean Treatment Cost - $43,1806

 PLAN
 Objective: Reduce rate of pressure ulcers in ICU settings
 Prediction:  pressure ulcers by at least 20%
 Skin Breakdown Protocol: Turn, Check, Apply, Reposition-
Standard Care
1. Hourly Rounding3
2. Turn every 2 hours3
3. Silicone foam dressing3
4. Wearable Patient Sensor8http://www.leafhealthcare.com/
 DO
 Carry out the plan: Nurse Leaders, Position for a unit-
based wound liaison nurse4

 Staff education4
 Involvement of nursing assistants4
 Document observations, Record data4
 STUDY
 During and 6 month following implementation of the
skin breakdown protocol:
 Determine how many pressure ulcers occur in the ICU.
 Comprehensive skin assessment survey.
 Braden scale, Q29
 Standardized pressure ulcer risk assessment9
 Care planning and implementation to address areas of
risk9

 Analyze data: Based upon results of skin assessments,

appropriate adjustment will be made to reduce the rate
of occurrence of pressure ulcers.
 SUMMARY
 ACT
 Discuss with staff who have a stake in the issue and
support implementing the program1

 Small group meetings and surveys1

 Gather information about barriers of awareness1
 Develop a list of resources needed1
 Identify and recruit project allies who can help spread
the word1

 Conduct a general staff awareness campaign1

 Implement skin checks for entire hospital1
 References
1. U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality.
(2014). Preventing pressure ulcers in hospitals. Retrieved from
https://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool1.html

2. Still M. D., Cross, L. C., Dunlap, M., Rencher, R., Larkins, E. R., Carpenter, D. L., … Coopersmith,
C. M. (2013). The turn team: a novel strategy for reducing pressure ulcers in the surgical intensive
care unit. Journal of the American College of Surgeons, 216(3), 373–379.
doi:10.1016/j.jamcollsurg.2012.12.001

3. Truong, B., Grigson, E., Patel, M., & Liu, X. (2016). Pressure Ullcer Prevention in the Hospital
Setting Using Silicone Foam Dressings. Cureus, 8(8), e730. doi.org/10.7759/cureus.730

4. Armour-Burton, T., Fields, W., Outlaw, L., & Deleon, E. (2013). The Healthy Skin Project: Changing
Nursing Practice to Prevent and Treat Hospital-Acquired Pressure Ulcers. Critical Care
Nurse,33(3), 32-39. doi:10.4037/ccn2013290

5. Keller, P., Wille J, Van Ramshorst, B., & Van der Werken, C. (2002). Pressure ulcers in intensive
care patients: a review of risks and prevention. Intensive Care Med, 28(10):1379-88.
doi10.1007/s00134-002-1487-z
 References Cont…
6. Department of Health and Human Services, Centers for Medicare and Medicaid Services,
Medicare Program; proposed changes to the hospital inpatient prospective payment systems
and fiscal year 2009 rates; proposed changes to disclosure of physician ownership in
hospitals and physician self-referral rules; proposed collection of information regarding
financial relationships between hospitals and physicians proposed rule. Fed
Reg.2008;73(84):23928–23938.http://edocket.access.gpo.gov/2008/pdf/08-
1135.pdf. Accessed March 19, 2013.
7. Department of Health and Human Services, Centers for Medicare and Medicaid
Services. Hospital-acquired conditions (HAC) in acute inpatient prospective payment system
(IPPS) hospitals: fact
sheet.http://www.cms.hhs.gov/HospitalAcqCond/Downloads/HACFactsheet.pdf.
Published October 2012. Accessed March 19, 2013.
8. Pickham, D., Berte, N., Pihulic, M., Valdez, A., Mayer B., & Desai, M. (2018). Effect of a
wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A
pragmatic randomized clinical trial (LS-HAPI study). International Journal of Nursing Studies,
80:12-19. doi:10.1016/j.ijnurstu.2017.12.012
9. Lima-Serrano, M., González-Méndez, M., Martín-Castaño, C., Alonso-Araujo, I., & Lima-
Rodríguez, J. (2018). Original: Predictive validity and reliability of the Braden scale for risk
assessment of pressure ulcers in an intensive care unit. Medicina Intensiva (English
Edition), 4282-91. doi:10.1016/j.medine.2018.01.007