Abstract
Background: The therapeutic use of respiratory (RT) devices in the ICU places patients at increased risk for the development of device related pressure injuries (PI). After a sustained elevation in RT device-related PI in the ICUs of a large academic children’s hospital, a quality improvement project was initiated. Goal: To decrease the incidence of RT device-related PI by 20% from baseline over a 9-month period. Methods: Patients admitted to the ICU of a pediatric academic medical center were evaluated for the outcome of RT device-related PI. Each PI was staged in accordance with the National Pressure Ulcer Advisory Panel. Data for hospital acquired PI was examined, and PI from RT devices were extrapolated and reported per 1000 inpatient days. Only stage 2 or worse PI were included in this evaluation (Stage 2, 3, 4, unstageable, and deep tissue injury). Interventions included: 1) Multi-disciplinary group assembly to focus on RT device-related PI 2) Skin care bundle recommendations during noninvasive ventilation (NIV) for both neonatal and pediatric applications 3) Education to clinicians for proper securement of endotracheal tubes (ETT) 4) Increased surveillance and documentation of skin assessments in the electronic medical record every 3-4 hours. Outcomes over a 9-month baseline were compared to a 9 month intervention period followed by evaluation of a 9 month sustainability period. Sustainability measures included frequent process measure audits and ongoing education to providers on service in the ICUs. Results: During the baseline period, RT device-related PI were associated with ETT (n = 9), pediatric NIV (n = 3), neonatal NIV (n = 5) and trach tube (n = 1). Baseline incidence rate for RT device-related PI was 0.4/1000 patient days, which decreased during the subsequent 9-month period (Figure 1). The skin protective strategies implemented resulted in a 55% reduction in the incidence of RT device related PI, and results were sustained for a 9-month period. Conclusions: A collaborative and multi-faceted pressure injury prevention strategy contributed to reducing skin harm, while allowing for the continued use of critical respiratory support devices. Acknowledgement: Our thanks to the JHACH department of Respiratory Care and the Save our Skin workgroup for their commitment to reducing patient harm.
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