Facility dramatically reduces pressure ulcers
Product changes, new processes achieves results
In 2008, the incidence of pressure ulcers in the ICU at Swedish Covenant Hospital in Chicago ranged from 11% to 13.6%. Today, a multidisciplinary task force has dispelled the myth that little can be done to prevent pressure ulcers in the ICU. "We were able to drop our rates to 1.8% in the ICU cumulatively over a six-month period, and the last four months we have seen 0% in the ICU while treating about 275 patients," reports Nancy Chaiken, ANP-C, CWOCN, RN, wound ostomy continence specialist and head of the hospital's skin breakdown prevention committee.
The committee, which has been meeting for a little more than two years, includes nurses and nurses' aides from every unit in the hospital, says Chaiken.
"Before I started here in 2004, we used an outside bed rental company to check incidence and prevalence of pressure ulcers once a year," says Chaiken. "When the committee formed, the administration decided to increase its importance and we started looking at pressure ulcer rates unit by unit on a monthly basis." Floor rates, she notes, were only at 1%-2%, so it was clear the greatest challenge was in the ICU.
Several changes made
As a result of the committee's recommendations, a number of changes were made. For example, in 2008 the hospital purchased all new pressure reduction mattresses for the med/surg units, including the ICU. "They are low air-loss mattresses," notes Chaiken, who says that in the general medical units, the pressure reduction mattresses are not as high quality. The beds, she adds, come with pumps that assist with pressure redistribution.
Skin barrier products also were changed; creams were purchased that can be applied to the skin so moisture from sweat and incontinence does not damage the skin. "We also use incontinence collection devices that help bring fluids away from the skin pads that go under the mattress to allow fluids to wick away from the body," Chaiken adds.
In terms of care processes, the nurses started monitoring the amount of times patients are turned. "You're supposed to do it every two hours," Chaiken says. "Compliance in the ICU is about 100%, and the rest of the hospital is about 95%."
In the ICU, pressure ulcer risk assessments using the Braden skin scale are done every day. If the score is low, Chaiken says, all prevention practices are initiated. "In the ICU, almost everyone is at risk for pressure ulcers," she explains.
Identification of pressure ulcers is emphasized, especially on admission. "We had cameras put in all units," Chaiken says. "If anyone came in and the nurse was not sure if they had a pressure ulcer, they were encouraged to take a picture, put the picture in the chart, and chart what they saw."
Education important
"We did a lot of formal and informal education," Chaiken says. The formal education included prevention, correct staging, and the definition of a pressure ulcer. "Because not all breaks in the skin are due to pressure ulcers, this is a really important piece to educate on," says Chaiken, who notes that the committee created several PowerPoint presentations and also brought in outside speakers.
As for informal education, she continues, "I was up there all the time with the nurses, turning patients and looking at skin. I can be a really good nagger."
There are unique challenges to getting staff onboard in the ICU, notes Chaiken. "You have critically ill patients who are sometimes at death's door," she points out. "So, for example, the patients' blood pressure is often dropping, and they are put on medications to raise it." But what that does is shunt blood away from the buttocks and heels and starts to cause more pressure ulcers, she notes.
"When staff are battling with these low pressures, they kind of think, 'Can we really prevent a pressure ulcer?'" she says.
Chaiken says she "had to get staff to buy into the concept that we can prevent them that we probably couldn't get them down to 0%, but we could get them down dramatically."
The key to getting that buy-in, she says, was a formal institutional review board study that was conducted with the approval of the hospital. "We started using a silicone dressing on the sacral area of everyone who was admitted to the ICU without a wound," Chaiken shares. "Patients who were undergoing long surgical procedures also had the cream placed on them in the operating room."
In the past, she notes, the cream had been used only when skin broke down. "This was given right off the bat," she notes. "This really dispels the myth that pressure ulcers are inevitable."
Despite the impressive results, the committee remains active. "We still look at every patient in the hospital for pressure ulcer development," says Chaiken.
"We are part of the National Data Nursing Quality Index, and we submit data on a quarterly basis." While they formally benchmark quarterly, "internally, we watch data on a monthly basis and address any potential problems a unit is having," says Chaiken. "The committee members are out there making sure everything is right this has really empowered the nurses."
In 2008, the incidence of pressure ulcers in the ICU at Swedish Covenant Hospital in Chicago ranged from 11% to 13.6%. Today, a multidisciplinary task force has dispelled the myth that little can be done to prevent pressure ulcers in the ICU.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content