Universal Pressure Ulcer Prevention Bundle with WOC Nurse Support
A quasi-experimental designed study that examined the effectiveness of a universal pressure ulcer prevention bundle and wound, ostomy continence nurse biweekly rounds on reducing the incidence of pressure ulcers in critical care.
Purpose: This study examined effectiveness of a universal pressure ulcer prevention bundle (UPUPB) applied to ICU patients combined with proactive, semi-weekly WOC nurse rounds. The UPUBP was compared to a standard guideline with referral based WOC nurse involvement measuring adherence to five evidence-based prevention interventions and incidence of pressure ulcers. An examination of WOC nurse rounds also occurred.
Design: The study used a quasi-experimental, pre/post design in which each phase included different subjects. Descriptive methods assisted in exploring the content of WOC nurse rounds.
Subject and Setting: The study included 181 pre and 146 post intervention subjects who met criteria of ≥ 18 years of age, no admission pressure ulcers, and admitted to ICU for >24 hours. The study included three ICUs located at North Memorial Medical Center in Minneapolis, Minnesota.
Methods: Data collection included admission/discharge skin assessments, chart reviews for five evidence-based interventions and patient characteristics, and rounding logs. Analysis included description of WOC nurse rounds, t-tests for guideline adherence, and multivariate analysis for intervention effectiveness on pressure ulcer incidence. Unit assignment, Braden score, and ICU length of stay were covariates for the multivariate model based on bivariate logistic regression screening.
Results: Pressure ulcers decreased from 15.5% to 2.1%. WOC nurses logged 204 rounds over 6-months, focusing primarily on early detection of pressure sources. Adherence increased for heel elevation (t = -3.905, df 325, p<.001) and repositioning (t = -2.441, df 325, p<0.015). Multivariate logistic regression modeling, adjusted for covariates, showed a significant reduction in pressure ulcers (Wald =17.879, df 1, p<.001). The intervention increased the Nagelkerke R-Square value by .099 (p<.001) above .297 (p<.001) when including only covariates, for a final model value of .396 (p<.001).
Conclusion: The UPUPB with WOC nurse rounds played a highly significant role in reducing pressure ulcers.
Key Words: Pressure ulcers, pressure ulcer prevention, pressure ulcer bundle, rounding
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