1591 Reducing hospital acquired pressure ulcers to the nares from tube securement

Suzanne Stewart, MS, RN, CWOCN, Robert Packer Hospital, Wound Ostomy Continence Nurse, Sayre, PA, Karen Colegrove, MS, RN, CCRN, Robert Packer Hospital, ICU clinical nurse specialist, Sayre, PA, Kelly Chapman, BSN, RN, Robert Packer Hospital, Wound, Ostomy, Continence Nurse, Sayre, PA and Lisa Jarvis, MS, RN, CCRN, Robert Packer Hospital, ICU nurse manager, Sayre, PA
Patients admitted to the intensive care unit are high risk for pressure ulcer development. At our facility these patients have a pressure ulcer risk assessment completed and prevention protocols put into place based on risk and nursing skin assessment. However this assessment does not include pressure ulcer risk from assistive devices, such as nasogastric tubes. In our facility over the last 3 years we have had 22 patients develop pressure ulcers from nasogastric tubes. This prompted a collaborative effort  to try a different securement device to positively impact these results and make a change in practice.  At our facility two securement devices were previously utilized.  Silk tape was used as well as a different tube attachment device. Securing the nasogastric tube without causing tension on the nares and preventing tube dislodgment is challenging. A review of securement devices was performed by the Hospital Nursing Skin Team and a  trial was initiated by the ICU clinical nurse specialist, WOCN and the surgical intensive care team. The trial consisted of securing the nasogastric tube in place with one of the holders as well as a hydrocolloid dressing to the cheek. The hydrocolloid dressing was discontinued early in the trial due to staff feedback. The trial continued utilizing just the securement device. The trial lasted from July 1, 2012- September 17, 2012 with a total of 45 patients include in the trial. Of the 45 patients, one patient developed a hospital acquired pressure ulcer to the nares. A significant reduction in hospital acquired pressure ulcers to the nares using the new securement device was evident.  A decision was made to obtain the new device and discontinue the previous practice. The implications for future nursing practice include close monitoring of patient’s risk for pressure ulcer development from assistive devices and equipment.