Pressure Ulcer Prevention in High-Risk Postoperative Cardiovascular Patients

Jackson, Melissa; McKenney, Teresa; Drumm, Jennifer; Merrick, Brian; LeMaster, Tamara; VanGilder, Catherine

doi:10.4037/ccn2011830

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Features| August 01 2011

Pressure Ulcer Prevention in High-Risk Postoperative Cardiovascular Patients

Melissa Jackson, RN;

Melissa Jackson, RN

Melissa Jackson was a unit manager at Saint Joseph Health System in Lexington, Kentucky, when this article was written. She is now a case manager at Integrated Care Management in Alpharetta, Georgia. Teresa McKenney is a certified wound ostomy and continence nurse at Saint Joseph Health System. Jennifer Drumm was a critical care clinical nurse specialist at Saint Joseph Hospital when this study was completed and now works as a critical care clinical nurse specialist at the University of Kentucky Chandler Medical Center in Lexington. Brian Merrick was a clinical manager in the cardiothoracic vascular unit at Saint Joseph Health System when this article was written. He is now a nurse manager at the Lexington Veterans Affairs Medical Center in Lexington, Kentucky. Tamara LeMaster is a nurse in the cardiothoracic vascular critical care unit at Saint Joseph Health System. Catherine VanGilder is a clinical research manager at the Hill-Rom Company in Batesville, Indiana.

Corresponding author: Melissa Jackson, rn, Integrated Care Management, 3440 Preston Ridge Road, Suite 300, Alpharetta, GA 30005 (e-mail: mjackson@integratedcare.com).

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Teresa McKenney, RN, BA, CWOCN;

Teresa McKenney, RN, BA, CWOCN

Melissa Jackson was a unit manager at Saint Joseph Health System in Lexington, Kentucky, when this article was written. She is now a case manager at Integrated Care Management in Alpharetta, Georgia. Teresa McKenney is a certified wound ostomy and continence nurse at Saint Joseph Health System. Jennifer Drumm was a critical care clinical nurse specialist at Saint Joseph Hospital when this study was completed and now works as a critical care clinical nurse specialist at the University of Kentucky Chandler Medical Center in Lexington. Brian Merrick was a clinical manager in the cardiothoracic vascular unit at Saint Joseph Health System when this article was written. He is now a nurse manager at the Lexington Veterans Affairs Medical Center in Lexington, Kentucky. Tamara LeMaster is a nurse in the cardiothoracic vascular critical care unit at Saint Joseph Health System. Catherine VanGilder is a clinical research manager at the Hill-Rom Company in Batesville, Indiana.

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Jennifer Drumm, RN, MSN;

Jennifer Drumm, RN, MSN

Melissa Jackson was a unit manager at Saint Joseph Health System in Lexington, Kentucky, when this article was written. She is now a case manager at Integrated Care Management in Alpharetta, Georgia. Teresa McKenney is a certified wound ostomy and continence nurse at Saint Joseph Health System. Jennifer Drumm was a critical care clinical nurse specialist at Saint Joseph Hospital when this study was completed and now works as a critical care clinical nurse specialist at the University of Kentucky Chandler Medical Center in Lexington. Brian Merrick was a clinical manager in the cardiothoracic vascular unit at Saint Joseph Health System when this article was written. He is now a nurse manager at the Lexington Veterans Affairs Medical Center in Lexington, Kentucky. Tamara LeMaster is a nurse in the cardiothoracic vascular critical care unit at Saint Joseph Health System. Catherine VanGilder is a clinical research manager at the Hill-Rom Company in Batesville, Indiana.

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Brian Merrick, RN;

Brian Merrick, RN

Melissa Jackson was a unit manager at Saint Joseph Health System in Lexington, Kentucky, when this article was written. She is now a case manager at Integrated Care Management in Alpharetta, Georgia. Teresa McKenney is a certified wound ostomy and continence nurse at Saint Joseph Health System. Jennifer Drumm was a critical care clinical nurse specialist at Saint Joseph Hospital when this study was completed and now works as a critical care clinical nurse specialist at the University of Kentucky Chandler Medical Center in Lexington. Brian Merrick was a clinical manager in the cardiothoracic vascular unit at Saint Joseph Health System when this article was written. He is now a nurse manager at the Lexington Veterans Affairs Medical Center in Lexington, Kentucky. Tamara LeMaster is a nurse in the cardiothoracic vascular critical care unit at Saint Joseph Health System. Catherine VanGilder is a clinical research manager at the Hill-Rom Company in Batesville, Indiana.

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Tamara LeMaster, RN;

Tamara LeMaster, RN

Melissa Jackson was a unit manager at Saint Joseph Health System in Lexington, Kentucky, when this article was written. She is now a case manager at Integrated Care Management in Alpharetta, Georgia. Teresa McKenney is a certified wound ostomy and continence nurse at Saint Joseph Health System. Jennifer Drumm was a critical care clinical nurse specialist at Saint Joseph Hospital when this study was completed and now works as a critical care clinical nurse specialist at the University of Kentucky Chandler Medical Center in Lexington. Brian Merrick was a clinical manager in the cardiothoracic vascular unit at Saint Joseph Health System when this article was written. He is now a nurse manager at the Lexington Veterans Affairs Medical Center in Lexington, Kentucky. Tamara LeMaster is a nurse in the cardiothoracic vascular critical care unit at Saint Joseph Health System. Catherine VanGilder is a clinical research manager at the Hill-Rom Company in Batesville, Indiana.

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Catherine VanGilder, MBA, BS, MT, CCRA

Melissa Jackson was a unit manager at Saint Joseph Health System in Lexington, Kentucky, when this article was written. She is now a case manager at Integrated Care Management in Alpharetta, Georgia. Teresa McKenney is a certified wound ostomy and continence nurse at Saint Joseph Health System. Jennifer Drumm was a critical care clinical nurse specialist at Saint Joseph Hospital when this study was completed and now works as a critical care clinical nurse specialist at the University of Kentucky Chandler Medical Center in Lexington. Brian Merrick was a clinical manager in the cardiothoracic vascular unit at Saint Joseph Health System when this article was written. He is now a nurse manager at the Lexington Veterans Affairs Medical Center in Lexington, Kentucky. Tamara LeMaster is a nurse in the cardiothoracic vascular critical care unit at Saint Joseph Health System. Catherine VanGilder is a clinical research manager at the Hill-Rom Company in Batesville, Indiana.

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Crit Care Nurse (2011) 31 (4): 44–53.

https://doi.org/10.4037/ccn2011830

Background

Little has been published about how to prevent pressure ulcers in severely debilitated, immobile patients in intensive care units.

Objective

To present a possible prevention strategy for postoperative cardiovascular surgery patients at high risk for development of pressure ulcers.

Methods

Staff chose to implement air fluidized therapy beds, which provide maximal immersion and envelopment as a measure for preventing pressure ulcers in patients who (1) required vasopressors for at least 24 hours and (2) required mechanical ventilation for at least 24 hours postoperatively.

Results

Only 1 of 27 patients had a pressure ulcer develop while on the air fluidized therapy bed (February 2008 through August 2008), and that ulcer was only a stage I ulcer, compared with 40 ulcers in 25 patients before the intervention.

Conclusions

Patients spent a mean of 7.9 days on the mattress, and the cost of bed rental was approximately $18000, which was similar to the cost of treatment of 1 pressure ulcer in stage III or IV (about $40000) and was considered cost-effective.

2011

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