Focus on the Patient 


The staff of UPMC Carlisle Intensive Care Unit

UPMC Carlisle

In 2019, UPMC Carlisle’s intensive care unit (ICU) had a problem: They had 25 unit-acquired pressure injuries in a 12-month period, approximately 50% of which were device-related. As a unit, they developed a plan to prevent injury to their most vulnerable patients that would encompass all the disciplines in their unit and increase their collective mindfulness. They all stepped up their game. Respiratory therapy started assessing skin around oxygen devices and communicating with primary nurses if they saw concerns with compromised skin. The physical therapy and occupational therapy teams helped reposition devices like sequential compression devices (SCDs) and if they noted any red or open areas they pulled in the primary nursing team for an assessment. The leadership team paired with the wound care nurse to complete “skin rounds” on all ICU patients weekly, ensuring the appropriate interventions were being used to prevent skin breakdown. Registered nurses and patient care techs made a commitment to ensure patients were being turned every two hours, offloading the areas at highest risk of pressure injury. Two RN skin checks were implemented for patients being admitted or transferred to the ICU. The collaboration of this entire team has led to a >50% reduction in pressure injuries in 2020. What an amazing accomplishment!


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