Semester

Summer

Date of Graduation

2026

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Stacy Huber

Committee Member

Holly Riley

Committee Member

Laurel Miner

Abstract

Background: Pressure ulcers are a significant concern for hospitalized patients, leading to various complications and increased medical costs. Despite common preventative interventions, pressure ulcer rates remain elevated. The prevalence of pressure ulcers contributes to patient suffering, extended hospital stays, increased healthcare expenses, and even fatalities. This emphasizes the critical need for additional prevention strategies. The reported increase in pressure ulcer injuries among spinal cord injury patients in the Surgical Intensive Care Unit (SICU), along with 7E and 8NE step-down units, at a large academic hospital highlights the pressing issue.

Purpose: The purpose of this project was to develop and integrate a practice guideline to standardize intermittent bedside pressure mapping on spinal cord injury patients to decrease the incidence of pressure injuries.

Intervention: The primary intervention was the development, integration, and staff education of a practice guideline for intermittent BPM for patients with a SCI initially admitted to the SICU.

Methods: The project used the Iowa Model framework to guide the development and integration of an intermittent bedside pressure mapping guideline and evaluate its impact on pressure ulcer incidence in the SICU, 7E and 8NE. The implementation incorporated intermittent bedside pressure mapping into a guideline for patients with a spinal cord injury in the SICU, 7E, and 8NE. The effectiveness of intermittent bedside pressure mapping in reducing pressure ulcer rates was assessed through chart audits to evaluate pressure ulcer incidence.

Results: Education on the BPM guideline reached 100% of nursing and clinical associate staff across all three units. 12 patients with SCI participated in this project. 58% were bedside pressure mapped in accordance with the guideline and three patients developed pressure ulcers. Patients that developed ulcers had longer average length of stays at 22.7 days compared to 14.7 days to patients that didn’t develop pressure ulcers. Missed pressure mapping and delays were due to device failure, order errors, and patient instability.

Conclusion: The DNP student successfully developed and integrated an intermittent BPM guideline. The guideline was unable to reduce the incidence of pressure ulcers to zero. This project demonstrates that not just a single factor plays a role in pressure ulcer development. Implementing an intervention that increases staff engagement and education is only one piece of the puzzle when combating this issue.

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