Effective Pressure Ulcer Management Techniques in ICU and Trauma Units

The Negative Consequences of Poor Pressure Ulcer Management

What Is The Problem?

Why Is The Problem Important And Relevant? What Would Happen If It Were Not Addressed?

What Is The Current Practice?

How Was The Problem Identified?

How Effective Is The Five Layer Silicon Bordered Dressings Technique When Applied In The Heal And Sacral Regions In Reducing Pressure Ulcers In The Icu And Trauma Units?

Despite the existence of various methods of pressure ulcer prevention, bedsores have remained among the most clinical challenges in Intensive Care Units(ICU) and trauma units in the hospital. Poor management of pressure ulcers has various negative consequences on the patient and their families, hospital,  general population and even at the national level(Krupp & Monfre, 2015)⁠. One major negative effect of Pressure ulcers in patients is that it affects both patients' psychological and physical functions in various ways. This includes decrease thought of self-worth due to damage to self-image, pain, risks for nosocomial infections due to increased hospitalization and disabilities(Krupp & Monfre, 2015)⁠. Chronic pressure ulcers can even affect patients' cardiovascular and immunological functions leading to further preventable complications(Krupp & Monfre, 2015)⁠. In addition, pressure ulcers increase cost on patients and their families due to prolonged hospitalization, increase the cost of care at the local and national levels as elated to high workload on nurses and physicians, long working hours and other tangible resources used during care delivery(Call et al., 2013)⁠. A survey was conducted between the years 1990 and 2001  concerning pressures ulcer prevalence found that the United States has the longest large scare scale prevalence that ranges between 9.2% and 15 % as compared to countries such as the United Kingdom and Germany(Dealey et al., 2013)⁠. Additionally, the cost of pressure ulcer management in the United States of America is large of which it is estimated to be around 15 billion dollars annually(Black et al., 2014). This demonstrates the magnitude of the problem and how it is affecting the economy of the United States. Therefore, effective methods of pressure ulcer management need to be established to combat this clinical problem.

Pressure ulcer prevention and management are significant to nurses, doctors, patients and the nation as a whole making it the topic of interest that needs to be addressed. Effective prevention and management of bedsores increase nurses’ and doctors’ working efficiency, reduce workload and long working hours and promote better working conditions(Black et al., 2014)⁠. This, in turn, increases their working moods, reduces absenteeism and promotes job satisfaction thus enhancing the delivery of high-quality care to patients(Krupp & Monfre, 2015)⁠. Other than that, understanding the proper management of bedsores increases nurses’ clinical skills and advances their careers. On the other hand, prevention of pressure ulcers reduces the cost of care to patients and hospital, promotes patients’ well-being, and reduce both related morbidity and premature mortality rates(Krupp & Monfre, 2015)⁠. In this regard, the clinical problem identified requires immediate attention that needs to be addressed to provide proper management techniques that reduce the cost of care and at the same time enhancing the quality and safe care to patients.

Importance of Effective Pressure Ulcer Prevention and Management

Failure to address this clinical challenge may lead to health care delivery problems that affect the national economy and well-being of patients(Dealey et al., 2013). Poor pressure ulcer management increases the cost of care that utilizes billions of money annually. This money can be used in the development of other economically advantaged projects that can boost the economy of the whole nation if pressure ulcers are managed effectively(Dealey et al., 2013)⁠. Other than that, failure to address this topic will lead to increase dependency ratio due to disabilities, a low number of active human resources, dissatisfaction among health workers and high cost of care that will only increase poverty levels.

Several current prevention and management practices are used in the prevention of pressure ulcers in hospitals. One of them includes the use of a patient turning technique(Boyko, Longaker, & Yang, 2016)⁠. In ICU and Trauma units, patient turning is done after every two hours to reduce the pressure at the prominent areas thus reducing the chances of patients developing bedsores(Boyko et al., 2016)⁠. This technique is effective and has been reported to help in many hospitals(Boyko et al., 2016)⁠. Secondly, evidence has shown that pressure ulcers can be reduced using alternating air mattresses and surfaces that do not promote bedsores. Finally, dressings have been proven to be an adjunct to bedsore prevention. To be specific, the use of five-layer silicon bordered dressings has proven to be effective in the reduction of pressure ulcers when combined with the above two pressure prevention practices(Santamaria et al., 2013). In this regard, patients are normally dressed immediately before being admitted to the ICU or at trauma units.

Safety and Risk Management Concerns

Quality Concerns

Unsatisfactory Patient, Staff, or Organizational Outcomes

Variations in Practice Within The Setting

Variations in Practice Compared to a Community Standard

Current Practice That has not been

P (population, patient or Problem) = ICU and Trauma Patients

I (Intervention) = use of five-layer silicon bordered dressings technique

C (comparison with other interventions) = Other interventions such as normal dressings, patient turning and use of alternating air mattress

O (outcomes are qualitative or quantitative measures to determine the success of the change) = At the end of the research period patient will demonstrate a significant decrease in the number of patients with bedsores and only a few and low non-complicated√ pressure ulcers will be seen.

References

Black, J., Clark, M., Dealey, C., Brindle, C. T., Alves, P., Santamaria, N., & Call, E. (2014). Dressings as an adjunct to pressure ulcer prevention: Consensus panel recommendations. International Wound Journal. https://doi.org/10.1111/iwj.12197

Boyko, T. V., Longaker, M. T., & Yang, G. P. (2016). Review of the Current Management of Pressure Ulcers. Advances in Wound Care. https://doi.org/10.1089/wound.2016.0697

Call, E., Pedersen, J., Bill, B., Black, J., Alves, P., Brindle, C. T., … Clark, M. (2013). Enhancing pressure ulcer prevention using wound dressings: What are the modes of action? International Wound Journal. https://doi.org/10.1111/iwj.12123

Dealey, C., Brindle, C. T., Black, J., Alves, P., Santamaria, N., Call, E., & Clark, M. (2013). Challenges in pressure ulcer prevention. International Wound Journal. https://doi.org/10.1111/iwj.12107

Krupp, A. E., & Monfre, J. (2015). Pressure Ulcers in the ICU Patient: an Update on Prevention and Treatment. Current Infectious Disease Reports. https://doi.org/10.1007/s11908-015-0468-7

Santamaria, N., Gerdtz, M., Sage, S., Mccann, J., Freeman, A., Vassiliou, T., … Knott, J. (2013). A randomized controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial. International Wound Journal,12(3), 302–308. https://doi.org/ 10.1111/iwj.12101