Collaborative Relationship between Nursing and the Respiratory Therapists in the Intensive Care Unit Leads to a Preliminary Hospital Acquired Pressure Ulcer Reduction related to Non Invasive Bi-level Positive Airway Pressure Masks

Topic:

Intensive Care Unit (ICU) recognized an increased use of non-invasive Bi-Level Positive Airway Pressure (BIPAP) was having unintended consequences of device related hospital acquired pressure ulcer (HAPUS). Prolonged BIPAP is more prevalent in critical care as a current intervention to decrease invasive ventilation and the potential of ventilator associated pneumonia.  Growth in BIPAP therapy has arisen from improvements in technology with low cost devices designed specifically to provide ventilatory support.

 Purpose:

The primary purpose of this practice innovation was to reduce the number of device related HAPUS in patients utilizing BIPAP masks.  Additional goals included: improving registered nurses (RN) and respiratory therapists (RT) documentation and strengthening multidisciplinary relationships. 

 Objective

RNs and RTs in critical care made a commitment to address the BIPAP HAPUS collaboratively. The practice innovation included trialing a new mask and silicone nasal pad. A standard of care protocol was developed and implemented, this including assessment, removing and refitting a BIPAP mask six times a day and documenting findings.  A BIPAP risk assessment skin condition is discussed on daily rounds. A HAPU skin treatment plan is developed by RN and RT to address patient’s clinical need.  The education strategy included RTs working in ICU completing the National Database for Nurse Sensitive Quality Indicators Pressure Ulcer Tutorial and providing practice inservices to RNs and RTs.

 Outcomes:

Device related HAPUS were evaluated prior to this practice innovation. Baseline data revealed 14 device related HAPUS in the previous six month period from December 2010 to May 2011. In the four months of the practice innovation the device related BIPAP HAPUS has decreased to 2 from July to October 2011. Sustaining continued success will be facilitated by: a continued collaborative approach between ICU nursing and Respiratory staff, emphasis on prevention, risk assessment and monthly audits of HAPU prevention BIPAP protocols.