Minimizing Mucosal Injuries: An Integrated Approach

Abstract

Background: Hospital-acquired pressure injury (HAPI) occurs when a localized injury to the skin or tissue is noted during an inpatient stay. HAPI is often associated with immobility, challenges with perfusion, severity of illness requiring diligent staging and monitoring to prevent further breakdown of the skin. Mucosal injuries are often staged differently due to no available keratinized epithelium on the mucosal surfaces. The recent COVID-19 pandemic has led to multiple admissions of mechanically ventilated patients into the ICU, causing an increase in the number of mucosal injuries. The purpose of this study is to understand how respiratory therapists (RTs) can assist in minimizing the number of mucosal injuries within intubated patients at UCSF.

Methods: An RT/RN HAPI committee was formed to bring awareness to the increasing number of mucosal injuries within the critical care areas. Consistency in once a week rounding on all intubated patients was maintained through institution of RT device-related HAPI champions. Awareness to RT HAPI champions were brought to staff working within the critical care units through daily reminders and weekly text pages to report any high-risk patients. HAPI log was created and shared with wound care nursing and RT staff. Education on skin integrity inspection, efficiency in reporting skin injury including attention to high-risk patients, was included as an annual skills review for RT staff. Competency in utilization of the ROVER app on Voalte phone was also attained for just in time information sharing and uploads to EPIC. Alternate ETT securement devices such as cloth taping was re-introduced to help prevent further skin break down. Use of skin protectors such as Cavalon and PolyMem products allowed for faster healing and a decreased breakdown of skin.

Results: Although sudden increase in mucosal injuries were noted, the number of mucosal injuries compared to previous fiscal year, was less than 18 incidences resulting in a 28% reduction in mucosal injuries reported per current fiscal year.

Conclusions: Active multidisciplinary collaboration and rounding within critical care areas can help with decrease of mucosal injuries within the critical care areas. Expansion of scope of practice to include skin integrity inspection by attaining adequate education opportunities, respiratory therapists can acquire knowledge outside their immediate field and contribute to comprehensive care.