PubMed · 11998227
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Alison Moore. 2002-04-17. Burning issue.. https://doi.org/10.7748/ns.16.31.16.s33
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Nursing staff in paediatric intensive care units (PICUs) regularly face a complex combination of nursing problems when admitting critically ill children. The assessment of skin integrity might not always be a priority during the initial period following admission. This article outlines some of the difficulties facing nurses involved in the care of critically ill children and reviews the literature on pressure ulcer assessment, highlighting the lack of a universal tool for risk assessment in this area. It also shows how a simple audit changed practice and reduced the incidence of pressure ulcer development in the PICU of the Royal Belfast Hospital for Sick Children over a two-year period.
The establishment of a discharge lounge is believed to have reduced pressure on beds in the wards. All adult wards refer patients to the lounge, where the average wait is two hours. The establishment of the lounge has reduced delays for ambulance crews who no longer have to collect patients from several areas of the hospital. Running costs for the first year were 30,000 Pounds. An agreement with the hospital pharmacy has been pivotal to the success of the scheme.
One major risk for the critically ill patient is the development of pressure ulcers during the intensive care unit (ICU) stay. These patients have many of the risk factors for the development of pressure ulcers including reduced mobility/activity, medications, neurologic deficits, increasing age, incontinence, decreased mental status, poor nutrition, pressure, shear forces, and friction. Pressure ulcers are known to be costly for the health care system and delay recovery in many patients. Different strategies have been advocated for the prevention of pressure ulcers, and the Agency for Healthcare Research and Quality (AHRQ) has identified the use of pressure relief bedding as a means to prevent the development of pressure ulcers during hospitalization. The use of pressure relief bedding has received the most research attention to date. The focus of this article is to describe the state of the current research in this area and how this applies to critical care. Development of protocols and guidelines for the use of pressure ulcer preventing strategies are important to improve the quality of care in the ICU. There is still a need to examine the impact of the evidence of pressure ulcer prevention in the ICU and this review should help to build a framework for future research and protocol development.