All-in-One Foam Dressing used Prophylactically to Prevent Sacrum Pressure Ulcers
This quality improvement project was a pilot for the use of the Mepilex Border Sacrum dressing as a cost effective health promotion measure to prevent the formation of sacrum pressure ulcers in the SICU. The primary outcome was to determine the effectiveness of using the Mepilex Border Sacrum dressing to reduce the incidence of hospital acquired pressure ulcers in the critically ill patient. The secondary outcome was to determine if this was a cost effective intervention.
Rationale
Despite new federal legislation and increased awareness, pressure ulcers in the critically ill population continue to be a problem since acuity as well as, contradictory protocols affect these patients more than any other hospitalized patient. This patient population is likely to suffer from poor nutritional status and edema both placing them at higher risk for ulcer formation. Other factors predisposing these patients to the formation of pressure ulcers are the use of vasopressors for hemodynamic stability and the use of sedation. Due to the negative financial implications organizations are emphasizing the need for preventative measures. The reduction of friction is an essential element in pressure ulcer prevention, therefore bringing the Mepilex Border Sacrum dressing to the forefront of viable options. In order to assess health care delivery individual patient outcomes are a priority, when those outcomes are tied to nursing quality benchmarks it is imperative they are addressed by specific nursing interventions as the one proposed by this quality improvement project.
Approach
The project took place in the 26 bed SICU of a level I trauma center. The critical care nurse applied a Mepilex Border Sacrum dressing to all patients over 18 years of age admitted to SICU during the implementation period who scored 15 or below on the Braden Scale. The skin and wound specialist nurse at the organization in conjunction with the author of this project assessed the sacral area underneath the dressing every day. Patients were followed during their stay in the organization even if they transferred to another unit.
Outcomes
Data obtained during the four-week implementation period was compared to data from the years 2011 and 2012 using descriptive statistics. Both project outcomes were met, as there were no pressure ulcers during the pilot period and the cost analysis showed the Mepilex Border Sacrum dressing to be a cost effective intervention. The intervention proposed by this project was proven to be effective in preventing sacral pressure ulcers, therefore positively impacting patient satisfaction and perceived quality of care.
Conclusions
Although future studies should include randomized control trials, including a heterogeneous critically ill population, results from this pilot are very encouraging. Long-term positive implications are expected for patients as well as for the organization.