Reducing the incidence of respiratory device related hospital acquired pressure ulcers in the ICU patients through a team approach

The purpose and objective of this initiative was to decrease the rate of facility acquired pressure ulcers related to respiratory devices in our intensive care unit. A trend in device related pressure ulcers was identified. A meeting was held to discuss interventions to prevent further ulcer development in patients requiring the use of NIV and CPAP masks and under tracheostomy face plates. After discussion with ICU staff, the critical care CNS, WOCN and respiratory therapy met to look at measures to decrease pressure ulcer development. The critical care committee approved the application of a mineral oil based pad to the nasal bridge as well as a thin silicone foam to the forehead prior to implementation of the mask. A separate discussion was held to determine the best treatment for prevention of pressure ulcers related to the tracheostomy face plate. After reviewing options, it was decided to use a silver foam trach dressing to absorb drainage, decrease maceration and pressure. Prompt removal of sutures after seven days was also reinforced.  Four months after implementation of the above measures there has been zero incidence of hospital acquired pressure ulcers related to the NIV/CPAP mask or tracheostomy sites when the above measures were completed. There was one incidence of a pressure ulcer development but it was determined that the mineral oil pad was not put in place per protocol. In conclusion, positive outcomes with a reduction in the incidence of hospital acquired pressure ulcers was achieved through a collaborative approach with the WOCN, the ICU CNS, ICU skin team, staff nurses and nurse manager, the critical care committee and respiratory therapy.