Continuous bedside pressure mapping and rates of hospital-associated pressure ulcers in a medical intensive care unit.

BACKGROUND: Critically ill patients are vulnerable to the development of hospital-associated pressure ulcers (HAPUs). Positioning of patients is an essential component of pressure ulcer prevention because it off-loads areas of high pressure. However, the effectiveness of such positioning is debatable. A continuous bedside pressure mapping (CBPM) device can provide real-time feedback of optimal body position though a pressure-sensing mat that displays pressure images at a patient's bedside, allowing off-loading of high-pressure areas and possibly preventing HAPU formation. METHODS: A prospective controlled study was designed to determine if CBPM would reduce the number of HAPUs in patients treated in our medical intensive care unit. In 2 months, 422 patients were enrolled and assigned to beds equipped with or without a CBPM device. Patients' skin was assessed daily and weekly to determine the presence and progress of HAPUs. All patients were turned every 2 hours. CBPM patients were repositioned to off-load high-pressure points during turning, according to a graphic display. The number of newly formed HAPUs was the primary outcome measured. A χ(2) test was then used to compare the occurrence of HAPUs between groups. RESULTS: HAPUs developed in 2 of 213 patients in the CBPM group (0.9%; both stage II) compared with 10 of 209 in the control group (4.8%; all stage II; P = .02). CONCLUSION: Significantly fewer HAPUs occurred in the CBPM group than the control group, indicating the effectiveness of real-time visual feedback in repositioning of patients to prevent the formation of new HAPUs.

A Continuous Bedside Pressure Mapping System for Prevention of Pressure Ulcer Development in the Medical ICU: A Retrospective Analysis.

OBJECTIVE: Patient repositioning to offload high-pressure areas is an essential component of pressure ulcer prevention for bed-bound patients. In most settings, the quantity and quality of offloading and repositioning are difficult to measure. Real-time continuous bedside pressure mapping (CBPM) offers an opportunity to do so. MATERIAL AND METHODS: Data was collected on 627 patients being treated in a medical intensive care unit (MICU): 307 patients placed on beds with a CBPM system and 320 historical controls placed on the same beds without the CBPM system 1 year prior to the study participants. A pressure ulcer prevention bundle was enhanced by the addition of a CBPM system that provides real-time digital imaging of the patient on the support surface to National Pressure Ulcer Advisory Panel guidelines. RESULTS: During the 2-month study period, 1 (0.3%) patient in the CBPM cohort developed a pressure ulcer compared with 16 (5%) patients in the historical cohort (P = 0.001). In a survey of the MICU care providers, 90% of respondents reported that the CBPM contributed to improved pressure detection and relief, 88% indicated the CBPM assisted them with repositioning protocols, and 84% reported the pressure map provided for more efficient and effective patient repositioning. CONCLUSION: Real-time, ongoing pressure measurement using a pressure-sensing mat may be a useful tool to help care providers effectively reposition patients within the context of existing standardized protocols for the prevention and minimization of pressure ulcers. .

Dedicated multidisciplinary ventilator bundle team and compliance with sedation vacation.

BACKGROUND: How compliance with a ventilator bundle is monitored varies from institution to institution. Some institutions rely on the primary intensive care unit team to review the bundle during their rounds; others rely on a separate team of health care personnel that may include representatives from disciplines such as nursing, respiratory therapy, and pharmacy. OBJECTIVES: To compare rates of compliance with ventilator bundle components between a dedicated ventilator bundle rounding team and the primary intensive care unit rounding team in a 68-bed medical intensive care unit. METHODS: A query of the medical intensive care unit's database was used to retrospectively determine rates of compliance with specific ventilator bundle components at a tertiary care hospital in an urban community for 1 year. RESULTS: Compared with the intensive care unit rounding team, the ventilator bundle rounding team had better compliance with sedation vacation (61.7% vs 54.0%, P < .001). Rates of compliance with spontaneous breathing trials and prophylaxis of peptic ulcer disease were similar in both study groups. CONCLUSIONS: A dedicated ventilator bundle rounding team improves compliance with sedation vacation, but not with spontaneous breathing trials and prophylaxis of peptic ulcer disease. In a large-volume tertiary center, a dedicated ventilator bundle rounding team may be more effective than the primary rounding team in achieving compliance with some bundle components.