Implementing a pressure ulcer prevention bundle in an adult intensive care

Intensive Crit Care Nurs. 2016 Dec:37:27-36. doi: 10.1016/j.iccn.2016.04.005. Epub 2016 Aug 28.


Background: The incidence of pressure ulcers (PUs) in intensive care units (ICUs) is high and numerous strategies have been implemented to address this issue. One approach is the use of a PU prevention bundle. However, to ensure success care bundle implementation requires monitoring to evaluate the care bundle compliance rate, and to evaluate the effectiveness of implementation strategies in facilitating practice change.

Aims: The aims of this study were to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of PUs, within ICU, and to evaluate the effectiveness of strategies used to enhance the implementation compliance.

Method: An observational prospective study design was used. Implementation strategies included regular education, training, audit and feed-back and the presence of a champion in the ICU. Implementation compliance was measured along four time points using a compliance checklist.

Results: Of the 60 registered nurses (RNs) working in the critical care setting, 11 participated in this study. Study participants demonstrated a high level of compliance towards the PU prevention bundle implementation (78.1%), with 100% participant acceptance. No significant differences were found between participants' demographic characteristics and the compliance score. There was a significant effect for time in the implementation compliance (Wilks Lambda=0.29, F (3, 8)=6.35, p<0.016), indicating that RNs needed time to become familiar with the bundle and routinely implement it into their practice. PU incidence was not influenced by the compliance level of participants.

Conclusion: The implementation strategies used showed a positive impact on compliance. Assessing and evaluating implementation compliance is critical to achieve a desired outcome (reduction in PU incidence). This study's findings also highlighted that while RNs needed time to familiarise themselves with the care bundle elements, their clinical practice was congruent with the bundle elements.

Keywords: Care bundle; Compliance; Implementation strategies; Pressure ulcer prevention bundle.

MeSH terms

  • Adult
  • Female
  • Humans
  • Intensive Care Units / standards
  • Intensive Care Units / statistics & numerical data
  • Male
  • Nurses / standards
  • Nurses / statistics & numerical data
  • Patient Care Bundles / instrumentation
  • Patient Care Bundles / standards*
  • Patient Care Bundles / statistics & numerical data
  • Pressure Ulcer / prevention & control*
  • Prospective Studies
  • Surveys and Questionnaires