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

Rosalind Elliott, RN, MN; Sharon McKinley, RN, PhD; Vicki Fox, RN, BN, Intensive Care Nursing Cert


Am J Crit Care. 2008;17(4):328-334. 

In This Article


Data were collected between November 2003 and January 2006. A total of 563 assessments of patients' skin were undertaken. The demographics of the patients assessed during the surveys were similar to the demographics of patients in other studies from Australian ICUs: the mean severity of illness (Acute Physiology and Chronic Health Evaluation II) score was 18, 64% were receiving mechanical ventilation (mean duration, 4.5 days), the mean length of ICU stay was 6.5 days, 60% were male, and the mean age was 58 years (range, 19-91 years).[19]

All patients surveyed were at some risk (ie, no patients were at no risk) for pressure ulcers. A total of 20% were at risk (score >10), 30% were at high risk, and 50% were at very high risk. The overall rate of pressure ulcers decreased from 50% in 2003 to 8% in 2005. The ICU monthly surveys from 2003 to 2006 revealed an overall downward trend in the severity (stages) of all ulcers (see Figure).

Number of ulcers by stage.

The source (the most likely location of the patient when the pressure ulcer developed) of the ulcer remained constant. A total of 75% were acquired in the ICU; 25% were acquired in other units, other hospitals, or the community. The most common sites of pressure ulcers also remained constant; that is, 60% of pressure ulcers occurred on the heels, 30% on the sacrum, and 10% in other parts of the body, including the occiput (related to cervical spine collars). The use of pressure-relieving devices for patients at high risk and very high risk increased from 75% during 2003 and 2004 to 95% to 100% during 2005 and 2006.


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