How Our ICU Decreased the Rate of Hospital-Acquired Pressure Ulcers

Ballard, Narendra; McCombs, Amy; DeBoor, Stephanie Stimac; Strachan, Julie; Johnson, Mellyn; Smith, Melissa Jill; Stephens, Kimberly; Pelter, Michele M.

doi:10.1097/01.ncq.0000303811.39737.b4

Cited by 28 publications

(19 citation statements)

References 7 publications

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“…[50][51][52][53][54] However, despite use of best-practice measures, pressure ulcers do occur. Critical care patients are at risk for unavoidable pressure ulcers, a condition that is now recognized by experts.…”

Section: Test Statisticmentioning

confidence: 99%

Vasopressors and Development of Pressure Ulcers in Adult Critical Care Patients

Cox

Roche

2015

American Journal of Critical Care

112

103

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Background Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied. Objective To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients. Methods A retrospective correlational design was used in a sample of 306 medical-surgical and cardiothoracic intensive care unit patients who received vasopressor agents during 2012. Results Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, mean arterial pressure less than 60 mm Hg in patients receiving vasopressors, cardiac arrest, and mechanical ventilation longer than 72 hours were predictive of development of pressure ulcers. Patients with a cardiac diagnosis at the time of admission to the intensive care unit were less likely than patients without such a diagnosis to experience pressure ulcers while in the unit. Conclusion The addition of vasopressin administered concomitantly with a first-line agent (often norepinephrine) may represent the point at which the risk for pressure ulcers escalates and may be an early warning to heighten strategies to prevent pressure ulcers. Conversely, because vasopressors cannot be terminated to avert development of pressure ulcers, these findings may add to the body of knowledge on factors that potentially contribute to the development of unavoidable pressure ulcers.

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Section: Test Statisticmentioning

confidence: 99%

Vasopressors and Development of Pressure Ulcers in Adult Critical Care Patients

Cox

Roche

2015

American Journal of Critical Care

112

103

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“…It is accepted that all patients should have an admission risk assessment to determine potential risk of pressure injuries developing as well as regular comprehensive skin assessment to detect existing or potential pressure injuries. [1][2][3]8,9 Waterlow is the risk assessment tool most commonly used for pressure injuries in Queensland, Australia. Webster et al 38 completed a single-center blind randomized controlled trial, enrolling 1231 patients admitted to internal medicine or oncology services to 3 groups for assessment of risk of pressure injuries: Waterlow (n = 410), Ramstadius (n = 411), or clinical judgment (n = 410).…”

Section: Process Of Care Measuresmentioning

confidence: 99%

“…7 Intensive care units (ICUs) have the highest prevalence and incidence of pressure injuries in the hospital setting. 8,9 Annual costs to treat pressure injuries in Australia are as high as A$285 million 7 and in the United States as much as $11 billion annually, 10 contributing significantly to patients' disease burden and ongoing health care costs.…”

mentioning

confidence: 99%

Reducing Pressure Injuries in Critically Ill Patients by Using a Patient Skin Integrity Care Bundle (Inspire)

Coyer¹,

Gardner²,

Doubrovsky³

et al. 2015

American Journal of Critical Care

122

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“…[31][32][33] Unit-based performance activities include teaching nursing staff how to identify risk factors and how to stage pressure ulcers, but the most important aspect of the quality initiatives appears to be in communicating the effectiveness of the therapy in terms of success in days without pressure ulcer development. [31][32][33] Unit-based quality initiatives that document the number of days that have passed between occurrences of hospital-acquired pressure ulcers are one way to communicate this success in preventing pressure ulcers from developing. Using a 2-nurse handoff report and assessment on admission and shift change, which includes conducting a skin assessment, reinforces individual accountability in interventions to prevent development of pressure ulcers.…”

Section: Use Of Preventive Measuresmentioning

confidence: 99%

Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit

Cooper

2013

Critical Care Nurse

116

112

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T he development of hospital-acquired pressure ulcers is a great concern in health care today. Pressure ulcer treatment is costly, and the development of pressure ulcers can be prevented by the use of evidence-based nursing practice. In 2008, the Centers for Medicare and Medicaid Services announced that they will not pay for additional costs incurred for hospital-acquired pressure ulcers.1 The development of a stage III or IV pressure ulcer is now considered a "never event."2 This change has resulted in an increased focus on preventive strategies and institutional scrutiny of pressure ulcers that develop in patients after hospital admission. The cost of 1 stage III or IV pressure ulcer may be between $5000 and $50000. 2The actual cost of pressure ulcers is not known because it is unclear what costs were included in estimates, such as nursing care costs, material costs, and added acute care days related to the development of a pressure ulcer. 3 In the intensive care unit (ICU), patients have multiple factors that increase the risk of pressure ulcers developing. Typically the patient has respiratory equipment, urinary catheters, sequential compression devices, multiple intravenous catheters, and the infusion of vasoactive agents for hypotension that may contribute to inability to turn patients and increase the risk of pressure ulcer development. This article discusses the multiple risk factors present in critical care for the development of pressure ulcers, current practices, and evidence for interventions aimed at preventing pressure ulcers.

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How Our ICU Decreased the Rate of Hospital-Acquired Pressure Ulcers

Cited by 28 publications

References 7 publications

Vasopressors and Development of Pressure Ulcers in Adult Critical Care Patients

Vasopressors and Development of Pressure Ulcers in Adult Critical Care Patients

Reducing Pressure Injuries in Critically Ill Patients by Using a Patient Skin Integrity Care Bundle (Inspire)

Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit

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