Alternative Pressure Ulcer Protocol


  • Some severe illnesses are still difficult to cure
  • Pressure ulcer is a disease provoked by prolonged pressure on tissues
  • Ulcers emerge in case of individuals’ inability to move
  • Any patient can be exposed to the injury
  • The project proposes proactive measures to prevent pressure ulcer

The Spirit of Inquiry Ignited

  • Pressure ulcer is most common in elderly patients as the result of insufficient nursing care
  • The condition is preventable as it may be caused by prolonged immobility of a patient (Coleman et al., 2014)
  • Pressure ulcer may be of four stages, affecting only the upper layer of the skin (stage 1), involving the partial-thickness (stage 2) or full-thickness loss of skin (stage 3), or resulting in tissue loss (stage 4) (Edsberg et al., 2016)
  • Patients having specific medical conditions limiting their mobility are vulnerable to the disease
  • The degrees of pressure resistance are different in soft tissue, muscle, and skin, with muscle having the lowest degree of resistance (Kirman, 2018)

The PICOT Question Formulated

Does the implementation of alternative pressure ulcer protocol compared to the usual treatment of pressure ulcer reduce its incidence during a hospitalization within a 3-day period of hospital admission?

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Search Strategy Conducted

  • Used databases: CINAHL, PubMed, Cochrane Database of Systematic Reviews, the National Guideline Clearinghouse, and TRIP Database
  • Keywords: pressure ulcer, pressure ulcer protocol, hospital-acquired pressure ulcer, emergency department.
  • The studies examined the emergence of pressure ulcers and the effective measures for its prevention
  • The search process result: several level I evidence studies

Critical Appraisal of the Evidence Performed

  • The study by Behrendt, Ghaznavi, Mahan, Craft and Siddiqui (2014): 422 patients, proves the usefulness of CBPM devises
  • The controlled trial by Gunningberg, Sedin, Andersson and Pingel (2017): 190 patients, no positive change
  • The study by Krishnan et al. (2016): 67 patients, suggests the use of the altering levels of inflammatory mediators
  • The research by Shi, Dumville and Cullum (2018): 42 studies of patients, no evidence between erythema and pressure ulcers
  • The study by Swafford, Culpepper and Dunn. (2016): proves the effectiveness of combined interventions
  • Evidence Integrated with Clinical Expertise and Patient Preferences to Implement the Best Practice

Evaluation Plan

  • Purpose: to decrease the percentage of pressure ulcer emergence among a high-risk group patients
  • Clinical question: Can precise observation, CBPM usage, and regular repositioning decrease the risk of pressure ulcer emergence?
  • Estimated time: 3 days
  • Stakeholders: the patients at risk and the nurses


  • Theoretical framework: complex system theory
  • Design: experiment-based
  • Confidentiality: ciphering of the data
  • Independent variables include age, gender, length of stay, pressure on ulcer-susceptible points
  • Selected range: 100 patients of 18-65 years old
  • Procedure: providing care using CBPM devices, skin observations, and other intensive protocols
  • Instrument: nurses’ reports

Outcome of Practice Change Evaluated

  • Evaluated data: incidence of pressure ulcers
  • The results will be formed according to the nurses’ reports
  • Major aspects will be compared to the initial data
  • Planned result: 0% of patients are diagnosed with PU after the 3-day hospital stay

Project Dissemination

  • The results will be disseminated to hospital staff
  • Nurses and direct participants will receive reports
  • The results will be discussed during conferences that will refer to alternative PU protocol
  • The findings will be available publicly


  • Aim: the risk of pressure ulcer emergence elimination
  • Result: studies suggest the use of proactive alternative methods
  • Study framework: complex systems theory and experiment-based design
  • Expectation: PU risk elimination and the emergence of the disease prevention


Behrendt, R., Ghaznavi, A. M., Mahan, M., Craft, S., & 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), 127-133.

Coleman, S., Nixon, J., Keen, J., Wilson, L., McGinnis, E., Dealey, C., … Nelson, E.A. (2014). A new pressure ulcer conceptual framework. Journal of Advanced Nursing, 70 (10), 2222–2234.

Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel pressure injury staging system: Revised pressure injury staging system. Journal of Wound Ostomy & Continence Nursing, 43(6), 1-13.

Gunningberg, L., Sedin, I. M., Andersson, S., & Pingel, R. (2017). Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial. International Journal of Nursing Studies, 72, 53-59.

Kirman, C. N. (2018). Pressure injuries (pressure ulcers) and wound care clinical presentation. Web.

Krishnan, S., Karg, P.E., Boninger, M.L., Vodovotz, Y., Constantine, G., Sowa, G.A., & Brienza, D.M. (2016). Early detection of pressure ulcer development following traumatic spinal cord injury using inflammatory mediators. Archives of Physical Medicine and Rehabilitation, 97(10), 1656-1662.

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Shi, C., Dumville, J. C., & Cullum, N. (2018). Skin status for predicting pressure ulcer development: A systematic review and meta-analyses. International Journal of Nursing Studies, 87, 14-25.

Swafford, K., Culpepper, R., & Dunn, C. (2016). Use of a comprehensive program to reduce the incidence of hospital-acquired pressure ulcers in an intensive care unit. American Journal of Critical Care, 25(2), 152-155.

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