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Bundle Decubitus
Bundle Decubitus
Bundle Decubitus
Prevention
Nursing Practice
Innovation
Pressure ulcers
This
Box 1. Pressure
ulcers: key facts
Skin integrity can deteriorate in hours
Frequent assessment prevents minor
damage from becoming major ulcers
Risk is predictable factors include
advanced age, immobility, sensory
problems, incontinence, poor nutrition,
This article describes the implementation of the SKIN (Surface, Keep moving,
Incontinence, Nutrition) Bundle assessment tool an initiative to reduce the incidence of pressure ulcers at University
Llandough Hospital, Cardiff and Vale University Health Board (C&V UHB). The SKIN
Bundle was piloted on the hospitals critical
care unit between May 2009 and April 2010.
Background
Nursing Practice
Innovation
5 key
points
Up to one in five
inpatients have
pressure ulcers,
which costs the
NHS up to 4bn a
year to treat
Risk factors
include age,
immobility,
incontinence and
poor nutrition
The SKIN
Bundle can
help prevent minor
skin problems from
becoming major
pressure ulcers
Its aims
include
identifying all
patients at risk and
significantly
reducing pressure
ulcers acquired in
hospital
The Model for
Improvement
can help the spread
and sustainability
of the SKIN Bundle
2
3
4
5
Waterlow
At risk? *Yes/No
N/T
Surface
Mattress
Repose boots
TEDs/heel
check
Keep moving
Position change
_______ hrly
Improved
moisture
management
Yes/No
Barrier cream
Consider
Flexiseal
Nutrition and
fluids
*WAASP
> 7 High Risk
NG/TPN/ Food chart
*Weight, Appetite, Ability to eat,
Stress fractures, Pressure ulcers
Discussion
88
84
80
76
72
Implementation
and spread
throughout unit
PDSA cycles on
different elements of
the bundle commenced
to achieve process
reliability
-2
0
0
9
6
-2
0
0
9
7
-2
0
0
9
8
-2
0
0
9
9
-2
0
0
9
10
-2
0
0
9
11
-2
0
0
9
12
-2
0
0
9
120
10
2
-2
01
0
3
-2
01
0
4
-2
01
0
5
-2
01
0
6
-2
01
0
7
-2
01
0
8
-2
01
0
9
-2
01
0
10
-2
01
0
11
-2
01
0
12
-2
01
0
68
Month
PDSA cycles
testing elements
of the SKIN Bundle
Implementing
the SKIN Bundle
Goal = 50
40
20
4/
2/
20
0
9
5/
10
/2
0
0
9
5/
18
/2
0
0
9
6/
1/
20
0
9
7/
10
/2
0
0
9
7/
14
/2
0
0
9
8/
28
/2
0
0
9
9/
13
/2
0
0
9
10
/4
/2
0
0
9
11
/3
/2
0
0
9
2/
24
/2
01
0
4/
30
/2
01
0
6/
28
/2
01
0
9/
15
/2
01
0
12
/2
3/
20
10
3/
18
/2
01
1
Conclusion
occurring. The IHI Model for Improvement is a simple and reusable model for
introducing rapid change, resulting in
sustained improvement. NT
References
National Institute for Health and Clinical Excellence
(2005) Pressure Ulcers: The Management of
Pressure Ulcers in Primary and Secondary Care.
London: NICE. www.nice.org.uk/cg29
National Patient Safety Agency (2010) NHS to
Adopt Zero Tolerance Approach to Pressure
Ulcers. London: NPSA. tinyurl.com/NPSA-ulcers
NHS Wales (2010) 1000 Lives Plus. Pressure Ulcer
Safety Cross. tinyurl.com/safety-cross
Reddy M et al (2006) Preventing pressure ulcers: a
systematic review. Journal of the American Medical
Association; 296: 974-984.
Vanderwee K et al (2007) Pressure ulcer
prevention in Europe: a pilot study. Journal of
Evaluation in Clinical Practice; 13: 2, 227-235.
Spl, Al Grant