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Interventions: In 2011, a review of the pressure ulcer data at SNS identified ear pressure ulcers, secondary to the use of oxygen tubing, as an area for improvement. Once identified, collaboration between the nursing and respiratory departments began immediately. Initially, the effort began with the identification of current practice, products and interventions that were being utilized by staff to prevent and treat pressure ulcers on the ears. Through collaboration, areas for improvement were identified.
The current product used for pressure relief of the oxygen tubing was less than optimal due to the difficult requirement of staff to apply the cushion product separately, as well as, needing to maintain proper placement of the cushion after application. It was determined to replace all current oxygen tubing in use to one that provided increased pressure relief and comfort. The product selected was implemented in June 2011. In addition, a change in practice was made requiring the respiratory department, along with nursing to assess patient’s skin under any respiratory device in use upon admission. In January 2012, a documentation flow sheet was created for skin assessment documentation by respiratory therapy. This created collaboration between the nursing department and the respiratory therapy department.
Lastly, in August 2012, a patient ready bag with a cushioned nasal cannula was placed in each patient room housing an oxygen flowmeter to maximize equipment readiness needs thereby increasing the prevention in ear pressure ulcerations while improving patient safety. To help with the effort, laminated signs were made and attached to each oxygen flow meter as a reminder to staff.
Outcomes: Incidence decreased with the implementation of the program. 6/10-5/11 rate/1000 patient days 0.14, 6/11-9/12 rate/1000 patient days decreased to 0.04.