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American Journal of Critical Care. 2008;17: 328-334
Copyright © 2008 by the American Association of Critical-Care Nurses.
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CE Article

Quality Improvement Program to Reduce the Prevalence of Pressure Ulcers in an Intensive Care Unit

By Rosalind Elliott, RN, MN, Sharon McKinley, RN, PhD and Vicki Fox, RN, BN, Intensive Care Nursing Cert. Rosalind Elliott is a clinical nurse consultant in the intensive care unit at the Royal North Shore Hospital, Sydney, Australia. Sharon McKinley is a professor of critical care nursing on the faculty of nursing, midwifery, and health at the University of Technology Sydney and Northern Sydney and Central Coast Area Health Service, Australia. Vicki Fox is a patient safety officer in the clinical governance unit of the Northern Sydney Central Coast Area Health Service, Australia.

Corresponding author: Rosalind Elliott, RN, MN, Intensive Care Unit, The Royal North Shore Hospital, St Leonard’s NSW 2067, Australia (e-mail: rmelliot{at}nsccahs.health.nsw.gov.au).

Background Critically ill patients are at increased risk for pressure ulcers, which increase patients’ morbidity and mortality. Quality improvement projects decrease the frequency of pressure ulcers.

Objectives To improve patients’ outcomes by reducing the prevalence of pressure ulcers, identifying areas for improvement in prevention of pressure ulcers, and increasing the adoption of preventive strategies in an intensive care unit.

Method Quasi-experimental methods were used for this quality improvement project in which 563 surveys of patients’ skin were performed during 22 audits conducted during a 26-month period. One-on-one clinical instruction was provided to bedside nurses during the surveys, and pressure ulcer data were displayed in the clinical area.

Results The frequency of pressure ulcers of all stages showed an overall downward trend, and the prevalence decreased from 50% to 8%. The appropriate allocation of pressure-relieving devices increased from 75% up to 95% to 100%. The likely origin of the ulcer (ie, whether it was hospital or community acquired) and the anatomical site of the pressure ulcers did not change during the study period.

Conclusions This program was successful in reducing the prevalence of pressure ulcers among vulnerable intensive care patients and indicates that quality improvement is a highly effective formula for improving patients’ outcomes that is easily implemented by using clinical expertise and existing resources.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe how quality improvement can be achieved without large expenditure by using existing resources.
  2. Understand that prevalence surveys provide great opportunities for quality improvement.
  3. Recognize that bedside clinicians are positively influenced by data feedback.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


Related articles in AJCC:

Clinical Pearls
Mary Jo Grap
AJCC 2008 17: 314. [Full Text]  

Evaluation of and Caring for Patients With Pressure Ulcers
Linda Bell
AJCC 2008 17: 348. [Full Text]  



This article has been cited by other articles:


Home page
 Am J Crit CareHome page
L. Bell
Evaluation of and Caring for Patients With Pressure Ulcers
Am. J. Crit. Care., July 1, 2008; 17(4): 348 - 348.
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