Methods Study Inclusion Criteria: Sedated patient on the ICU > 5 days May or may not be intubated Braden score of < 16 Patients not eligible for Prevalon™ boot included in the study as control subjects with pillows used to elevate the heels. Passive ROM as ordered on all ICU patients was not withheld or viewed as a variable in the prevention of plantar flexion contractures. Procedure: 1. Skin assessment and Braden scale administered to all patients upon admission to the ICU. 2. All ICU patients meeting criteria had an initial measurement of ankle ROM done with a goniometer upon admission and prior to application of the Prevalon™ boot. Braden scale, heel skin assessment, and Ramsey sedation scale were also documented. 3. All applicable patients then had ankle ROM measured every other day. 4. Heel assessments, Braden scale, and Ramsey sedation scale were done every shift, and recorded as part of the study every other day. 5. Measurements continued until patient was either transferred, boots were discontinued by physician, or patient had a Braden scale of greater than 16. 6. Control patients also had ankle measurements, heel skin assessment, Ramsey sedation scale, and Braden scale done at admission and every other day. 7. Identified and trained ICU nurses and physical therapists performed the measurements. S S u u c c c c e e s s s s f f u u l l P P r r e e v v e e n n t t i i o o n n o o f f H H e e e e l l U U l l c c e e r r s s a a n n d d F F o o o o t t D D r r o o p p i i n n t t h h e e H H i i g g h h R R i i s s k k V V e e n n t t i i l l a a t t i i o o n n P P a a t t i i e e n n t t P P o o p p u u l l a a t t i i o o n n Tina Meyers, BSN, RN, CWOCN, ACHRN, Rejeana Pezel, ICU/CCU, Jill Bennett, RN, MSN, ICU/CCU, Vanessa Carroll, RN, ICU/CCU, Ann Russell, RN, BSN, ICU/CCU, Sharon Lagway, RN, ICU/CCU, Salvacion Ramos, RN, ICU/CCU, Eloisa Asilo, RN, ICU/CCU, Marci Green, RN, ICU/CCU nurse Conroe Regional Medical Center , Conroe TX Poster presented at the 19th Annual National Forum on Quality Improvement in Health Care : December 9-12, 2007 21040
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Methods
Study Inclusion Criteria: � Sedated patient on the ICU >5 days
� May or may not be intubated
� Braden score of <16
� Patients not eligible for Prevalon™ boot included in the study as control subjects with pillows used to elevate the heels.
� Passive ROM as ordered on all ICU patients was not withheld or viewed as a variable in the prevention of plantar flexion contractures.
Procedure:
1. Skin assessment and Braden scale administered to all patients upon admission to the ICU.
2. All ICU patients meeting criteria had an initial measurement of ankle ROM done with a goniometer upon admission and prior to application of the Prevalon™ boot. Braden scale, heel skin assessment, and Ramsey sedation scale were also documented.
3. All applicable patients then had ankle ROM measured every other day.
4. Heel assessments, Braden scale, and Ramsey sedation scale were done every shift, and recorded as part of the study every other day.
5. Measurements continued until patient was either transferred, boots were discontinued by physician, or patient had a Braden scale of greater than 16.
6. Control patients also had ankle measurements, heel skin assessment, Ramsey sedation scale, and Braden scale done at admission and every other day.
7. Identified and trained ICU nurses and physical therapists performed the measurements.
SSSS uuuu cccc cccc eeee ssss ssss ffff uuuu llll PPPP rrrr eeee vvvv eeee nnnn tttt iiii oooo nnnn oooo ffff HHHH eeee eeee llll UUUU llll cccc eeee rrrr ssss aaaa nnnn dddd FFFF oooo oooo tttt DDDD rrrr oooo pppp iiii nnnn tttt hhhh eeee HHHH iiii gggg hhhh RRRR iiii ssss kkkk VVVV eeee nnnn tttt iiii llll aaaa tttt iiii oooo nnnn PPPP aaaa tttt iiii eeee nnnn tttt PPPP oooo pppp uuuu llll aaaa tttt iiii oooo nnnn
Tina Meyers, BSN, RN, CWOCN, ACHRN, Rejeana Pezel, ICU/CCU, Jill Bennett, RN, MSN, ICU/CCU, Vanessa Carroll, RN, ICU/CCU, Ann Russell, RN, BSN, ICU/CCU, Sharon Lagway, RN, ICU/CCU, Salvacion Ramos, RN, ICU/CCU, Eloisa Asilo, RN, ICU/CCU, Marci Green, RN, ICU/CCU nurse Conroe Regional Medical Center , Conroe TX
Poster presented at the 19th Annual National Forum on Quality Improvement in Health Care : December 9-12, 200721040
Ramsey Score Averages Score Entry Totals Exit Totals
1 7 7 8 8 2 22 44 20 40 3 3 9 9 27 4 11 44 11 44 5 7 35 4 20 6 0 0 0 0
Avg. 2.78 2.67
Modified Ramsey Sedation Scale: 1. Anxious, Agitated, Restless 2. Cooperative, Oriented, Tranquil.
Accepts mechanical ventilation. 3. Responds to commands only4. Brisk response to light glabellar tap or loud noise. 5. Sluggish response to light glabellar tap or loud noise. 6. No Response.
1. Keller BP, Wille J, van Ramshorst B, van der Werken C. Pressure ulcers inintensive care patients: a review of risks and prevention. Intensive CareMed. 2002;28:1379-1388.
2. Jastremski CA. Pressure relief bedding to prevent pressure ulcerdevelopment in critical care. J Crit Care. 2002 Jun;17(2):122-5.
3. Latronico N, Shehu I, Seghelini E. Neuromuscular sequelae of criticalillness. Curr Opin Crit Care. 2005;11:381-90.
4. Whittington KT, Briones R. National prevalence and incidence study: 6-yearsequential acute care data. Adv Skin Wound Care. 2004;17:490-494.
5. Courtney B, Ruppman J, Cooper H; "Save Our Skin: Initiative cutspressure ulcer incidence in half." Nursing Management. April 2006;36-45.
6. Hoppenfeld S. (1976). Physical Examination of the Spine and Extremities.Norwalk, CT:Prentice-Hall;1976.
7. Kapandji IA. Ilustrated Physiology of Joints. Med Biol Illus. 1964;14:72-81.
8. Kendall FP, McCreary EK, Provance PG, et al. Muscles: Testing andFunction with Posture and Pain. 5th ed. Baltimore, MD:Lippincott Williamsand Wilkens;2005.
9. Young ZF, Evans A, Davis J. Nosocomial pressure ulcer prevention: asuccessful project. J Nurs Adm. 2003;33:380-383.
Data Collection Tool for Conroe Hospital Prevalon II Plantar Flexion Prevention
MRN_________________________ AGE_____________ GENDER ____________
DIAGNOSIS____________________________________________________________
ADMISSION DATE________________________________
INTUBATED: YES or NO DATE__________________
SEDATED: YES or NO DATE__________________
PREVALON BOOT APPLIED: YES or NO PILLOWS USED: YES or NO
Ankle Measurement
Braden Scale
Heel Skin Assessment
Ramsey score Comments
Admission
Day 3
Day 5
Day 7
Day 9
Day 11
Day 13
Day 15
References
Related Documents
