Implementing foam-silicone dressings in the ICU To Reduce pressure ulcer formation

1. Implementing foam-silicone dressings in the ICU To Reduce pressure ulcer formation By: Kathryn Fox, RN Ferris State University Background Implications Research question Study design Preventing pressure ulcer (PU) formation in the hospital setting is an ongoing clinical problem. The Joint Commission (2008) found that more than 60,000 patients expire annually related to pressure ulcer complications. Decreasing pressure ulcers acquired in the hospital setting is especially important due to the economic climate of healthcare cost reduction. Hospital acquired pressure ulcers (HAPUs) are not reimbursed by the centers for Medicare and Medicaid Services (CMS). Acutely ill patients are at higher risk of developing a PU, in fact intensive care unit patients average Braden Scale is 15, compared to a score of 19 for medical-surgical patients (Chaiken, 2012). Current measures utilized to prevent the formation of a PU include frequent repositioning, adequate nutrition, heel protection, applying moisture barrier cream, and keeping the head of the bed less than 30°, and while these are effective acutely ill patients in the ICU setting are still experiencing skin breakdown and PUs. Research shows that patients who acquire PUs have increased complications and higher morbidity rates (Santamaria et al., 2012). • Implementing the use of foam silicone dressings applied to the coccyx every 72hrs and PRN based on risk-assessment has the potential to: • Reduce the formation of HAPU’s, • Increase patient’s quality of care • Save health care facilities valuable dollars. • Improve patient satisfaction Does the prophylactic use of foam silicone dressings combined with standard preventative measures reduce the number of patients acquiring HAPU’s in the intensive care unit setting when compared to standard preventative measures currently in place? • Qualitative Research Design studying the effects of prophylactic foam silicone dressing application in relation HAPU’s. • Participants will be consenting patients admitted from the ED meeting pressure ulcer risk assessment criteria. Assignment to the control and experimental group will be random and evenly distributed. • Data collection will be obtained through a clinical trial of applying foam silicone dressings in addition to preventative measures for 6 mo. compared to preventative measures only. These trials will be held simultaneously • Limitations • The preventative measures in place may be difficult to implement on all patients (i.e. Ventilated patients typically have the HOB >30). Possibly skewing results. • Patients meeting criteria for the study may opt out, the number of admissions during the six month study period may decrease possibly altering percentages. • No HAPU’s may occur in either group during the study References Chaiken, N. (2012). Reduction of sacral pressure ulcers in the intensive care unit using a silicone border foam dressing. Journal of Wound, Ostomy, & Continence Nursing, 39(2), 143-145. Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., … Knott, J. (2013). A randomised 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, 1-7. doi: 1.1111/iwj.12101 The Joint Commission. (2008). Strategies for preventing pressure ulcers. Joint Commission Perspectives on Patient Safety, 8(1), 5-7