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J Nurs Care Qual Vol. 20, No. 1, pp. 56–62 c 2005 Lippincott Williams & Wilkins, Inc.
Nosocomial Pressure Ulcer Rates in Critical Care
Performance Improvement Project
Cheryl Lynn Wolverton, MSN, RN, CCRN; Lisa A. Hobbs, BSN, RN, CWOCN; Terrie Beeson, BSN, RN, CCRN; Marianne Benjamin, MSN, RN; Karen Campbell, MSN, RN, CNRN; Charlie Forbes, BSN, RN, CCRN; Nicole Huff, RD, CD; Michelle Kieninger, BSN, RN, CWOCN; Michael Luebbehusen, BSN, RN; Mary Myers, BSN, RN; Susan White, MSN, RN, CNS Assessment, monitoring, and prevention of pressure ulcers in the hospitalized patient are required standards of care. The annual nosocomial pressure ulcer (NPU) rates for the adult intensive care units at our facility had trended up to 33% from 14% over a 13-month period. Our performance improvement team decided to track 5 variables that may have contributed to the increased incidence of NPU. Weekly skin care rounds were conducted to collect data, educate staff, and reinforce skin care policy and standards of care. Data analysis revealed 3 areas that required further emphasis with nursing staff: daily assessment with the Braden Scale, prevention of NPU beginning on the day of hospital admission, and the effect of sedation on patient mobility. Implementation of appropriate interventions targeted to specific Braden subscales needs to be included in the plan of care. Key words: Braden Scale, nosocomial pressure ulcer, performance improvement, prevention of pressure ulcers
NGOING assessment, monitoring, and prevention of pressure ulcers in the hospitalized patient are required standards of care for the nursing profession as well as mandated by regulatory agencies. Our facility meets the required standards pertaining to pressure ulcer assessment in part through the collection of prevalence data obtained during an annual survey process. Prevalence is defined
From the Indiana University Hospital (IU), Clarian Health Partners, Indianapolis, Ind. We thank Cassie Oakes for her patience and perseverance in preparing the manuscript and for her support with the data entry process. Corresponding author: Cheryl Lynn Wolverton, MSN, RN, CCRN, IU Hospital, Clarian Health Partners, 550 N University Blvd, UH 6407, Indianapolis, IN 46202 (e-mail:cwolvert@Clarian.org). Accepted for publication: January 28, 2004
as the percentage of patients with pressure ulcers among all patients surveyed.1 Prevalence surveys are valuable tools to monitor performance indicators for practice and process improvement, and are used as a method for benchmarking and to establish best practice standards. However, prevalence surveys provide only a snapshot picture, which may not provide enough information to draw conclusions or determine problems and associated root causes. Therefore, a more frequent survey to determine the incidence of nosocomial pressure ulcers (NPUs) may provide the needed information. Incidence is defined as the percentage of patients who develop pressure ulcers after admission to the setting.1 The wound ostomy continence (WOC) nurses collected annually the data on the incidence of NPUs in our intensive care units (ICUs).
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Nosocomial Pressure Ulcer Rates in Critical Care Our facility is a 330-bed tertiary academic medical center located in the Midwest. The adult ICUs (surgical, medical, and neurological) consist of 39 beds for patients who have primary diagnoses such as craniotomy, liver transplantation, major chest procedures, and pulmonary and gastrointestinal-related illnesses. The ICU leadership team noted a 19% overall increase in the NPU rates in our ICUs from the previous survey period. We assembled a team to develop a performance improvement (PI) project. Our PI team consisted of nurse educators, clinical managers, expert staff clinicians, WOC nurses, and a registered dietitian (RD). The PI...