RefeRences:

Black J, Cuddigan J, Walko M, et al. (2010). Medical device-related (MDR) pressure ulcers in hospitalized patients. International Wound Journal, 7(5):358-365.

Jacobson T, Tescher A, Miers A, et al. (2008). Improving practice: efforts to reduce occipital pressure ulcers. Journal of Nursing Care Quality, 23(3):283-288.

Weng. (2008). The effect of protective treatment in reducing pressure ulcers for non-invasive ventilation patients. Intensive & Critical Care Nursing, 5:295-299.

Background: Quarterly pressure ulcer prevalence studies revealed an increasing number of device-related hospital acquired pressure ulcers (HAPU) on the head and neck at our urban acute care hospital and Level 1 Trauma Center, primarily in CVICU and ICU.

Purpose: To reduce the number of device-related HAPU in the ICU by 1) assisting and instructing bedside RNs in the ICU to establish a routine pattern of assessing skin under devices on the head & neck, and 2) identifying barriers/facilitators to following the APPLE+ protocol.

Method: Advanced Practice Nurses (APNs) rounded three times/week for 4 weeks in the ICU to instruct and review APPLE+ protocol. The APNs also administered a 3 question qualitative, semi-structured interview survey. APPLE+ is the following:

■ Assess ears when initiating oxygen.

■ Protect skin from friction.

■ Pad tubing with foam.

■ Loosen tubing to prevent friction.

■ educate and Evaluate.

■ + head and neck assessment, lips by assessing ET tube, under masks, collars, immobilizers, and suction devices/NG tape.

Outcomes: Device-related HAPU decreased in the ICU to zero after the intervention. CVICU rates decreased until March 2012. 54 percent of ICU nurses agreed APPLe+ guidelines should be implemented at least once/shift. Ideas to prevent device-related PU centered on three themes: protective padding, change/collaborate with RT on ETT taping or stabilization, and cervical collar protocols.

next steps: Phase II study in collaboration with RT began in April 2012. A new ETT stabilizer will be used on non-trauma ICU patients.

Phoenix, Arizona n JCL.com

A Multi-Phase study Aimed at Reducing Device-Related Hospital Acquired Pressure Ulcers in IcU Patients

AUtHORs:

Debra Beauchaine, MN, ANP, CWCN

Cheryl Karam, MS, ANP, CWOCN

Stuart Russell, BSN Nursing Student

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Perc

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Percent of Surveyed Patients in ICU and CVICU with Head & Neck Device- Related Pressure Ulcers September 2010 through March 2012

ICU Device Related Head & Neck PU/Pts Surveyed X 100 CVICU Device Related Head & Neck PU/Pts Surveyed X 100

34%

37%

29%

Ideas to Prevent Device-Related Pressure Ulcers in the ICU

Protection/Padding ET Tube Cervical Collars