Translating evidence-based pressure injury prevention strategies to the intensive care environment; the SUSTAIN study

Background

Intensive care units (ICUs) have the highest rates of hospital-acquired pressure injuries (PIs) with Australian rates reported from 18-50%.1,2 These figures demonstrate a lack of sustained translation of best available evidence into practice and an imperative for change to skin management practice in this vulnerable patient population and unique practice environment.

Aim

This multi-phased study aimed to 1) identify potential adopters and attributes of the evidence-based skin integrity management and PI prevention for translation to practice; 2) implement targeted research translation strategies; and 3) monitor the uptake of the strategies. This presentation reports findings from aim three.

Method

This study, conducted in a 36 bed ICU of an Australian tertiary referral teaching hospital, used a prospective observational audit design. Over 52 weeks, weekly skin integrity prevalence audits were conducted by trained research nurses on ICU patients who met all of the inclusion, and none of the exclusion, criteria. Data collected included patient demographic characteristics and skin integrity loss (stage and location), and RN adherence to the ICU processes of care.

Results

A total of 928 patients were audited; 55% were male, mean age was 55.5 years, and mean ICU length of stay of 8 days. Pressure injury prevalence trended from 16% at the commencement of the audit to 9% at completion; a decrease of 0.14% per week over 52 weeks. Further, increased diligence in routine patient skin assessment and reporting of skin injuries by bedside RNs was noted.

Conclusion

This initiative demonstrates a successful novel approach which assisted RNs to refocus their attention in prioritising patient skin care in the challenging ICU environment. Raising awareness of evidence-based best practice in PI prevention was shown to be a positive vehicle for education and professional development, enhancing a collaborative multidisciplinary team approach to patient care.

References

  1. Coyer F, Gardner A, Doubrovsky A et al. Reducing pressure injuries in critically ill patients by using a patient skin integrity care bundle (InSPiRE). Am J of Crit Care. 2015;24(3):199-209.
  2. Tayyib N, Coyer F, Lewis P. Pressure ulcers in the adult intensive care unit: a literature review of patient risk factors and risk assessment scales. JNEP. 2013;3(11):28-42.
National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EUAP) and Pan Pacific Pressure Injury Alliance (PPPIA). Prevention and treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed.). 2014; Cambridge Media: Perth, Australia.

Authors: Coyer FM1,2, Campbell J3, Vann A2, McNamara G, Cook J-L1, Dubrovsky A.1

Affiliations:

  1. School of Nursing, Queensland University of Technology
  2. Intensive Care Services, Royal Brisbane and Women’s Hospital
  3. Skin Integrity, Royal Brisbane and Women’s Hospital.