International consensus on pressure injury preventative interventions by risk level for critically ill patients : A modified Delphi study

The aim of this modified Delphi study was to determine a minimum pressure injury preventative intervention set for implementation relative to critically ill patients' risk level. Preventative interventions were identified via systematic review, risk levels categorised by an intensive-care-specific risk-assessment-scale (COMHON Index), and panel members (n = 67) identified through an international critical care nursing body. Round 1: panel members were asked to rate implementation of 12 interventions according to risk level (low, moderate, high). Round 2: interventions were rated for use at the risk level which received greatest round 1 support. Round 3: interventions not yet achieving consensus were again rated, and discarded where consensus was not reached. Consensus indicated all patients should receive: risk assessment within 2-hours of admission; 8-hourly risk reassessment; and use of disposable incontinence pads. Additionally, moderate- and high-risk patients should receive: a reactive mattress support surface and a heel off-loading device. High-risk patients should also receive: nutritional supplements if eating orally; preventative dressings (sacral, heel, trochanteric); an active mattress support surface; and a pressure-redistributing cushion for sitting. Repositioning is required at least 4-hourly for low-risk, and 2-hourly for moderate- and high-risk patients. Rigorous application of the intervention set has the potential to decrease pressure injuries in intensive care.