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International Journal of Advances in Nursing Management
Year : 2018, Volume : 6, Issue : 2
First page : ( 125) Last page : ( 129)
Print ISSN : 2347-8632. Online ISSN : 2454-2652.
Article DOI : 10.5958/2454-2652.2018.00029.X

Effectiveness of care bundle for hospital acquired pressure ulcer in ICU

Dr. Sachdeva Seema1,*, Dr. Koul Pity2, Dr. Batra Kiran3

1Nursing Tutor, College of Nursing, AIIMS

2Director and Professor, School of Health Sciences

3Principal and Professor, Silver Oak College of Nursing, Punjab

*Corresponding Author E-mail: sachdevaaiims@gmail.com

Online published on 21 August, 2018.



Patient safety has always been most important aspect of clinical practice. Critical ill patients are at high risk of complications due to severity of condition, invasive nature of procedures, treatments modalities, and use of multiple drugs. In addition to it adverse events and preventable error are major risk in ICU. Among these preventable error, hospital acquired pressure ulcer (HAPU) is one of the most common condition which increase the chance of infection, sepsis, loss of functioning, forced immobility and hence increase hospital stay and financial burden.


To assess the nurse's outcome in terms of knowledge and practices on Hospital acquired pressure ulcer before and after implementation of protocol; To assess the patient's outcome in terms of complications related to Hospital acquired pressure ulcer before and after implementation of protocol; To find the association of nurses and patients outcome with selected variables.


Quasi experimental with non equivalent pre test post test control group design was used to conduct the study in a selected hospital of NCR, Delhi during 7 months period (May to December 2016). The sample size was 60 for nurses and 145 for patients divided in control and experimental group. The sampling technique was total enumeration sampling for nurses and simple random sampling for patients. The tools used were ‘Nurse Outcome Measurement Sheet ’(Knowledge questionnaire and skill checklist on Hospital acquired pressure ulcer prevention practices) and ‘Patient Outcome Measurement Sheet ’(Incidence of Hospital acquired pressure ulcer). Protocol and tools were developed and validated before actual intervention. After pre test (May to August 2016) done in both groups, the protocol on care bundles for Hospital acquired pressure ulcer prevention practices was administered to experimental group over the period of 1 week. The post test was done on nurses and patients in both groups was done after a gap of 1 month. p value <0.05 was considered statistically significant.


After the intervention, the knowledge increased significantly in experimental group than control group. The skill in terms of compliance rate for using care bundles improved from 52% to 77% in experimental group after protocol administration. Nurses outcome had significant association with demographic variables like education and experience at the level p<0.05. For patient's demographics, average ICU stay was 6.7 days, the majority of patients with respiratory system disorders (59%), had Glasgow coma scale (GCS) of 9–12 (73%). The incidence of Hospital acquired pressure ulcer was significantly decreased in experimental group than control group than after administration of protocol. VAP rate decreased to 0.60 from 1.34 per 100 patient days. HAPU had significant association with duration in ICU (>72 hrs). Conclusion: The protocol was effective in terms of improving nurses and patients outcomes.



Nurse Outcome, Patient Outcome, Hospital acquired pressure ulcer (HAPU).


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