1609 Alternative Uses for Usual Products

Michelle Beck, RN, BSN, CWOCN1, Terrie Beeson, MSN, RN, CCRN, ACNS-BC2, Lori Arnold, RN, CWOCN3, Deborah Kleissler, RN, CWOCN1 and Ashley Moore, RN, WTA4, (1)IU Health West Hospital, Nurse Clinician, Avon, IN, (2)Indiana University Health, Clinical Nurse Specialist, Indianapolis, IN, (3)IU Health Methodist, Nurse Clinician, Indianapolis, IN, (4)IU Health West Hospital, Shift Coordinator, Avon, IN
Thinking Outside the Box to Reduce Hospital Aquired Pressure Ulcers (HAPU)

Purpose:  Decreasing the number of HAPU in an Acute Care Community Hospital Setting.

Back ground:  During skin care rounds, our hospital had an increase of deep tissue injury (DTI) to bilateral heels and device related injury to the nostril/nare from naso-gastric tube (NGT).  The patients who developed DTI to the heels had increased length of stay, multiple procedures, were up in bedside recliners with foot rest extended and were admitted from the Emergency Department (ED).  The patients found to have device related breakdown from the NGT, complained of pain and discomfort at the nare unrelieved by re-taping the tube in place.

Investigation of the Problem:  We used a low profile, real time, pressure mapping system to assist with determining the amount of pressure that the patients may have been exposed to while in the recliner with the foot rest up as well as on the transport and ED carts.

The NGT could not be removed and re-taping the tubes did not help. Therefore, foam wraps were used to offload NGT presssure.

Results: Pressure readings of the patient’s heels while in the recliner with the footrest extended were 70 mmHg higher without a static air cushion. Pressure readings were 20-70 mmHg higher for heels and sacrum without a static air cushion on transport and ED carts.

Closed cell foam wraps were placed around NGT in an effort to decrease pressure between NGT and mucosa of the nose for those patients with rigid NGT that are oriented straight out rather than in downward position.

Conclusions/Implications for Practice:  We are thinking outside the box - using usual products in different ways to improve patient satisfaction and comfort as well as to decrease our HAPU.