Running Head: PRESSURE ULCERS

Pressure Ulcers: Preventative Practices in the Intensive Care Unit

A pressure ulcer, or bedsore, can best be defined as an area on the body that has
encountered a form of rubbing or pressing to the extreme of cutaneous breakdown. The
breakdown of the skin is caused by decreased blood flow to the particular location on the
body due to various physical aliments or barriers. As the skin begins to breakdown, the
pressure ulcer is placed into a series of categories based on the level of severity labeled I
through IV. This particular journal article begins to address what risk factors are
associated with cutaneous breakdown and pressure ulcer development, as well as the
preventative measures that should be taken in order to decrease the likelihood of such
cases within the Intensive Care Unit in order to provided more effective care for the
patient as well as cost reduction for the hospital. Cooper (2013) highlights the question:
What more can be done within the Intensive Care Unit to prevent the occurrence of
hospital-acquired pressure ulcers, and what observatory methods must be implicated?
Coopers (2013) research article titled: Evidence-Based Prevention of Pressure
Ulcers in the Intensive Care Unit, specifically hones in on the direct observation,
prevention, and identifiers of such skin breakdown in patients hospitalized within the
Intensive Care Unit, or ICU. The Intensive Care Unit is designed for critically ill patients
that are in need of constant support and treatment. It is important to note that although
such patients within these units are monitored regularly, pressure ulcers are identified
within this group of individuals at an alarmingly high incidence rate. The patients being
evaluated within this particular study are those who are encountering treatment within the
Intensive Care Unit. They are placed in a series of categories, marking where and from
what any developed pressure ulcers may have derived from. Cooper (2013) discusses the

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series of causative agents in the skin breakdown process, specifically highlighting the
lack of pressure redistribution on hospital mattresses, devices, friction, pressure,
moisture, medications, quality assurance, as well as malnourishment or overall nutritional
standing.
Pressure Ulcers are prevalent in all hospital settings still today. Specifically,
Cooper (2013) notes that these particular forms of cutaneous breakdowns are found in
the ICU [ranging] from 10% to 41% (p. 58) in incidence rate. This is an alarmingly high
number, seeing as these particular patients are already in a unit for critical care. Cooper
(2013) notes that within previous studies, no specific indicator or predictor for pressure
ulcers within these critical care units was derived from the research. In order to prevent
the pressure ulcers or bedsores, studies prior to Coopers (2013) furthered development
concluded that with routine rotation as well as elevation skin breakdown could be
avoided if no specific indicator or predictor was available.
The statistical analysis of incidence rate that was previously noted is identified
primarily through direct observation. Cooper (2013) identifies a pressure ulcer or bedsore
through the visual indicator of reddened skin or clearly a distinguishable wound at a
particular location on the body. The evidence-based journal article continues the
generalized observation of such skin breakdown into four categories or stages. Cooper
(2013) indicated the classifications of pressure ulcers as identified in the chart
represented in table 1 (p. 58).

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As displayed above - without the preventative care or early observation of a pressure

ulcer a patients condition can get progressively worse over time. In order to accurately
collect observational data, the medical personnel must thoroughly exam the patients
body from head to toe noting any precursors that may indicate the beginning or
advancement of a pressure ulcer. Through direct patient analysis and data collection, it is
important to note the prevalence as well as the incidence rate of pressure ulcers within the
Intensive Care Unit.
This article identifies pressure ulcers, how they may be observed, as well as
preventative measures. In correlation to actively preventing skin breakdown within the
hospital setting - the findings of this evidence-based research as indicated by Cooper
(2013), is that constant education of all nursing and medical staff is necessary for the
continuous improvement in the quality of care provided to patients. Providing the
identifiable risk factors, communication, as well as the traits of each staged pressure ulcer

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falls within the education that must be provided to all medical personnel in order to
actively prevent and treat pressure ulcers. Cooper (2013) identifies the direct beneficial
influence of unit-based quality assurance projects (p. 65) in the act of preventing such
bedsores in patients hospitalized within the Intensive Care Unit as well. It is also
important to note that all body surface areas should be regularly examined during each
medical or nursing staff rotation or more often, depending on the status of the patient.
Although specific findings were derived from this article, Cooper (2013) specifically
places emphasis on the need for additional research as well. This additional research
would be beneficial in identifying pressure ulcers related to device usage, as well as to
further educate the medical community on additional preventative measures for hospitalacquired bedsores.
As stated previously, pressure ulcers are a common occurrence within the hospital
setting as well as outside of it. The prevention of hospital-based pressure ulcers is
important and relevant to the nursing practice not only because of the steeply increasing
medical costs, but also for the improvement in the quality of care provided to each
individual patient. Cooper (2013) noted that as of 2008, additional costs acquired due to
hospital-developed pressure ulcers would no longer be covered. It takes a substantial
amount of money to treat and prevent infection in the later stages of a pressure ulcer,
making the process and the procedure costs detrimental to further financial growth and
development within the hospital. By preventing pressure ulcers, medical billing costs will
subside in correspondence with wound care and treatment. Nurses and all medical
personnel should apply preventative actions effectively in order to prevent pressure ulcers
as a whole, as well as limiting further stage development in any noted areas of concern.

PRESSURE ULCERS

This can be completed by utilizing the knowledge of factors or causative agents of a

bedsore and limiting an individuals exposure to such sources, remaining up to date on
knew education material in regards to hospital-acquired pressure ulcers, and regularly
checking each patients dermis for signs or symptoms of cutaneous breakdown.
The implementation of preventative measures of pressure ulcers are clearly
outlined, however there are barriers that may interfere with the completion of such
precautionary actions. Potential barriers that may surface involve the risk assessment
process and the imitations that may hinder the nurse or hospital employee. A risk
assessment is a complete collection of all potential risk factors that an individual may
have. The information is collected upon hospital admittance via a history report, physical,
as well as a series of laboratory testing. However risk assessments can be incomplete,
and substantial information may not be included within the report or documentation. The
primary causative agents for an incomplete risk assessment are: lack of time, distraction,
attitudinal, and inadequate reimbursement.

For example: a nurse has a patient in the Intensive Care Unit. The patient is currently
being interviewed about their dietary nutrition. The nurse is quickly rushed out of the
room for another patient on the floor that is currently coding. This would be an example
of a distraction towards the successful completion of a risk assessment. If the nurse had
successfully completed the risk assessment as desired, she would have learned that the
patient is extremely malnourished making them more susceptible for pressure sores.

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Additional difficulties that may surface in the prevention of pressure ulcers may deal with
the facility itself, and what preventative measures they can afford. It is, however
important to provide an excellent quality of care to each patient, regardless of barriers
and potential difficulties faced by the nurse or the facility as a whole entity.
An area on the body that has encountered a form of rubbing or pressing to the
extreme of cutaneous breakdown, commonly identified as a pressure ulcer or bedsore, is
extremely apparent in the hospital setting. In efforts to prevent pressure ulcers, risk
factors, proper education, and detailed observation must be implicated. Although proper
guidelines and preventative measures are in place, it is important to note that further
research is necessary in order to continuously improve on procedures and observatory
methods. It is also important to take into consideration the potential difficulties and
barriers that a nurse or other medical staff may face when completing a risk assessment.

PRESSURE ULCERS
Reference
Cooper, K. (2013). Evidence-Based Prevention of Pressure Ulcers in the Intensive Care
Unit. Critical Care Nurse, 33(6), 57-66. Retrieved October 14, 2014.