Pressure Ulcer Prevention Audit Report: ICU, Singapore Hospital

This report details an audit plan focused on pressure ulcer prevention, a critical healthcare concern, particularly within the geriatric population in Singapore. The audit aims to assess current practices in an ICU setting, adhering to NICE guidelines and addressing the increasing incidence and healthcare costs associated with pressure ulcers. The report outlines the rationale, which emphasizes the impact on patient safety, increased hospital stays, and mortality rates. It defines audit standards, including risk assessment using tools like the Braden scale, skin assessments, repositioning protocols, and care planning. The audit poses five key questions regarding best practices, frequency of assessments, care planning, and available resources. The study will be conducted in a private hospital's ICU, involving geriatric patients, ward nurses, and medical staff. The report also references relevant literature and aims to improve patient outcomes and reduce the burden of care related to pressure ulcers.

Running head: PRESSURE ULCER PREVENTION
Pressure ulcer prevention
Name of the Student
Name of the University
Author note

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PRESSURE ULCER PREVENTION
Topic and Rationale
The topic for the audit is pressure ulcer prevention and the reason for choosing it is that it
is a burning health problem resulting in increase in morality and healthcare costs especially in
the geriatric population (Behrendt et al. 2014). Every year, 2.5 million people are developing
pressure sores and that bring pain with serious risk for infection and increased utilization of
healthcare. There is also increased reimbursement of patients to hospitals and require adequate
care in pressure ulcer under the hospital care. Moreover, pressure ulcer demands interdisciplinary
approach to care and high tailored and routine care. As Singapore population is ageing, it is
battling with pressure sores in hospitals and need measures on a greater urgency (Chang, Carville
and Tay 2016). According to Gunningberg et al. (2015) one in ten geriatric patients are
struggling with pressure sores where they are admitted for more than a week at the hospital. At
the Changi General Hospital (CGH), 15% patients in geriatric wards get pressure ulcers or sores
until task force combat it. It also adds to the cost of healthcare and demands adequate care. This
depicts that it is a major health issue affecting millions of patients and increase in hospital stays
affecting patient safety and quality of care (Woo et al. 2017). Along with incidence, mortality
rates are also increasing resulting in readmissions and increase in costs. This is the reason to
choose the topic of pressure ulcer prevention for the audit as it is an emerging nursing concern
and increasing the burden of care.
Audit standards
The standard criteria to be used for the pressure ulcer prevention will be under the NICE
guidelines that encompass the potential challenges and priorities to collect data for the audit plan.
The audit tool detects the clinical issues and guidelines that are suitable for the development of

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the audit standards for the proposal. It provide recommendation guidelines like to prevent
patient’s declining treatment
Audit standards Definitions
Risk assessment Braden scale or Norton assessment scale or
Waterlow score that support clinical judgment
Skin assessment Skin integrity, colour changes, moisture,
firmness and heat variance.
Repositioning none
Pressure redistributing equipments none
Care planning Outcome of risk, skin assessment, mobility,
additional pressure, mobility, co-morbidities
The 5 audit questions are:
What are the best practices for the pressure ulcer prevention that the hospital have?
How often the comprehensive assessment of skin is conducted in the hospital?
How often the pressure ulcer risk assessment is conducted and according to standard
guidelines?
How should the care planning for pressure ulcer should be done based on the risk?
What additional resources the hospital have in identifying the best practice for the
prevention of pressure ulcers?

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Audit setting
The audit will be conducted in the hospital setting in a private hospital in Singapore. It
will be conducted in Intensive Care Units (ICU) that is 22 bedded and provide care for the
complex assessments and treatment.
Population and sample setting
The audit will be undertaken in the ICU setting in hospital where the population size will
be 30 people comprising of geriatric patients, ward nurses in wound dressing and ICU medical
staffs. The stakeholders involved in this audit plan will be the commissioners, clinical leaders at
every hospital level, managers in clinical governance, working staffs, carers in the clinical audit
program. The sample will be selected who have impaired mobility and bed-ridden.

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References
Behrendt, R., Ghaznavi, A.M., Mahan, M., Craft, S. and Siddiqui, A., 2014. Continuous bedside
pressure mapping and rates of hospital-associated pressure ulcers in a medical intensive care
unit. American Journal of Critical Care, 23(2), pp.127-133.
Chang, Y.Y., Carville, K. and Tay, A.C., 2016. The prevalence of skin tears in the acute care
setting in Singapore. International wound journal, 13(5), pp.977-983.
Gunningberg, L., Mårtensson, G., Mamhidir, A.G., Florin, J., Muntlin Athlin, Å. and Bååth, C.,
2015. Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a
descriptive, comparative multicentre study in Sweden. International wound journal, 12(4),
pp.462-468.
Woo, K.Y., Sears, K., Almost, J., Wilson, R., Whitehead, M. and VanDenKerkhof, E.G., 2017.
Exploration of pressure ulcer and related skin problems across the spectrum of health care
settings in Ontario using administrative data. International wound journal, 14(1), pp.24-30.