Pressure ulcer prevention in mechanically ventilated patients in intensive care units: a quality improvement project.

Abstract

Despite ongoing attempts to prevent hospital-acquired pressure ulcers (HAPUs), they remain a common occurrence in hospitalised patients. Improving policies and processes to provide a standardised approach to assessments, documentation and equipment is linked to decreasing HAPUs. Among hospitalised patients, those in intensive care units (ICUs) and who are mechanically ventilated are at the highest risk of developing a pressure ulcer (PU). A quality improvement (QI) project was created to provide a foundation of basic nursing care to be delivered to the patient for the prevention of HAPUs. The primary objective of the QI project was to decrease the incidence of HAPUs at the author's facility, Mercy Hospital, Arkansas, US. The year prior to the implementation of the QI project, the HAPU incidence was n=17 in the ICU at this facility. This article highlights the importance of education, training and the use of a preventive dressing upon admission to the ICU. It can be used as an approach to improve current policies. The overall length of the QI project including education, implementation and monitoring was 12 weeks. The framework used in the QI project was that of Failure Modes and Effects Analysis. The outcome of this QI project resulted in a reduction of HAPUs. Within the 12-week timeframe, one HAPU developed. An effective prevention tool was the use of a preventive dressing at pressure points (coccyx/sacral) upon arrival to the ICU before an injury occurred. Providing continuous structured education on interventions for the prevention of HAPUs was found to be a successful component of prevention during this QI project. Although many of the risk factors, such as poor perfusion and lack of mobility, for HAPUs are not able to be prevented, the incorporation of evidence-based research into practice in the clinical setting can facilitate a reduction in the prevalence of HAPUs.