Lost in translation? Interpreting universal pressure injury prevention guidelines into a practical reference for intensive care

Abstract

International guidelines for pressure injury prevention (PIP) apply equally to all general and specialty nursing areas. However, intensive care unit (ICU) patients are a unique population due to their severity of illness. Not only are these patients susceptible to pressure injuries (PIs) over bony prominences, they are at increased risk for medical device-related pressure injuries from chemical restraint, physical restrictions, and the many invasive procedures they undergo. The juxtaposition of urgent life-saving interventions with the adherence to best practice PIP guidelines poses problems for nursing staff who constantly juggle these priorities. In our ICU these challenges were highlighted during the weekly skin integrity nursing rounds and from analysis of the integument-related patient incident reports. To develop an evidence-based, clinical guideline that integrates PIP strategies into a tertiary intensive care context as a strategy to reduce PI prevalence. A survey of nurses’ perceptions of barriers, enablers and attitudes towards pressure injury prevention and skin integrity care was conducted in combination with focus groups. The need for an ICU-specific guideline was identified. Collaboration with the ICU nursing leadership and medical team, hospital skin integrity service and quality and safety unit, resulted in the development of a clinical guideline with simplification of the PI risk assessment categories, clarification of PIP strategies in ICU and documentation recommendations to improve consistency and minimise skin disruptions. An ongoing reduction in the prevalence and incidence of PIs in the ICU occurred that was evidenced by weekly PIP prevalence audits from 16% to 9% over 6 months and other reporting measures. Implementation of a standardised, evidence-based approach to PIP and skin integrity optimisation with expert collaboration and explicit interpretation in an intensive care context should be considered in order to achieve sustained PI reduction.