Background of Problem
Pressure injuries are a recurrent problem in the hospital setting especially amongst ICU patients. The critical conditions present in these patients restricts their ability to independently move in the bed. This can be a significant issue amongst ventilated and sedated patients as they rely on their nurses to provide interventions to prevent these injuries. Neglecting to provide measures to prevent pressure injuries can result in longer recovery times and hospital acquired infections. For ICU nurses, the importance of incorporating these interventions into their patient care can help further complications from developing.
Research from the Health Research & Educational Trust indicates that pressure injuries impact approximately 2.5 million patients (CHPSO, 2017). The prevalence of pressure injuries amongst ICU patient is high due to their hemodynamic instability (Labeau et al., 2020). Pressure reduction interventions are needed in the ICU setting to help produce better patient outcomes. Studies also show that 36% of pressure injures have occurred in specialty areas, such as the ICU (CHPSO, 2017).
A study called The Decubitus in Intensive Care Unit, conducted research finding that of the 3,526 patients reviewed 3,997 pressure injuries were found amongst the individuals (Labeau et al., 2020). Lack of pressure injury interventions can result in pain, lengthy hospital stays, compromised quality of life, and increased expenses (Labeau et al., 2020). Sacral pressure injuries account for 26-48% of all pressure injury development (Al-Dorzi, 2021). Turning their patients every two hours, proper nutrition, padding skin-to-skin contact, and elevating pressure points are all preventative measure that should be done (Johns Hopkins Medicine, n.d.).
Importance to Nursing
Pressure injuries are easily preventable and it’s essential for nurses to provide pressure injury reduction practices into their care of their patients. Assessing for factors that influence pressure injuries including immobility, malnutrition, low Braden Scale score, and moisture can help nurses to identify appropriate interventions (Al-Dorzi, 2019). ICU patients, especially the ventilated and sedated, are at increased risks for this development. Working in the ICU, I have seen firsthand just how quickly these pressure injuries can occur. Stressing the need to provide the appropriate measures can produce positive patient outcome.
Improvement in Patient Outcomes
Studies have shown that the implementation of mobility teams for turning ICU patients was shown to have a significant decrease in hospital acquired pressure injuries (Al- Dorzi, 2019). Not only do these interventions act as preventable measures, but they also help to prevent subsequent infection contraction that may be associated with open pressure sores. Better patient outcomes result when these measures are in place. Quicker recovery times and improvement in health conditions can be seen.
Well Worded Clinical Question
In the ICU setting, is the intervention of turning ventilated and sedates patients every 2 hours as effective as only using pressure redistribution beds for reducing pressure injuries.
Identification of PICOT Elements
P- Critical ICU patients specifically those who are ventilated and sedated (male or female).
I- Use of turning teams to turn critical ICU vented and sedated patients every 2 hours.
C- Use of pressure redistribution beds for critical ventilated and sedated patients in the ICU.
O- Reduced evidence of pressure injures evident by no skin breakdown on the sacrum and heels.
T- Within 2 months.
References
Al-Dorzi, H. (2019, May 30). Www.sccj-sa.org. Prevention of Pressure Injuries in the Intensive Care Unit. Retrieved April 2, 2022, from https://www.sccj-sa.org/printarticle.asp?issn=2543-1854;year=2019;volume=3;issue=1;spage=61;epage=72;aulast=
CHPSO. (2017, August 4). By the numbers: CHPSO pressure injury data. By the Numbers: CHPSO Pressure Injury Data. Retrieved April 2, 2022, from https://www.chpso.org/post/numbers-chpso-pressure-injury-data
Johns Hopkins Medicine. (n.d.). Pressure injuries. Pressure Injuries. Retrieved April 2, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/pressure-injuries
Labeau, S., Afonso, E., Benbenishty, J., Blackwood, B., Boulanger, C., Brett, S., Calvino-Gunther, S., Chaboyer, W., Coyer, F., Deschepper, M., François, G., Honore, P., Jankovic, R., Khanna, A., Llaurado-Serra, M., Lin, F., Rose, L., Rubulotta, F., Saager, L., … Blot, S. I. (2020, October 9). Prevalence, associated factors and outcomes of pressure injuries in Adult Intensive Care Unit Patients: The DECUBICUS study – intensive care medicine. SpringerLink. Retrieved April 2, 2022, from https://link.springer.com/article/10.1007/s00134-020-06234-9
