Cushion those Devices to Protect Skin Integrity

There has been an increasing amount of attention focused on hospital-acquired pressure ulcers (PUs).  As recently as 2009, CMS stated they would not pay the treatment costs of any PU that progresses to stage III or IV during hospitalization. As a result, health care facilities implemented strategies to prevent PUs and established programs to report the incidence of PUs.  Often this data is benchmarked through national nursing collaboratives like the National Database of Quality Indicators (NDNQI) and Patient Safety Healthcare Engagement Network (HEN).

Skin injuries related to medical devices used in a pediatric hospital contribute to the majority of hospital-acquired PUs. At our hospital 70% of the hospital-acquired PUs are device-related noted from our monthly prevalence studies. In a two year time frame, we recorded 152 device-related, hospital-acquired PUs with respiratory/airway devices as the leading cause. General factors contributing to these device-related PUs include edema, moisture, friction, shearing, impaired sensation, young child's inability to communicate, lack of subcutaneous tissue, child's anatomy, poor fitting devices, and the child's clinical condition.

A "SKIN IS IN" awareness campaign began at our hospital four years ago but most recently the emphasis has been devoted to the device-related PUs. The APN WOCN met with various interdisciplinary practitioners to establish best practice related to medical devices and the prevention of PUs. The APN WOCN implemented a "Cushion and Protect" resource tool to standardize care and alleviate the pressure of fifteen medical devices. Outcomes were measured at the monthly housewide prevalence studies as well as through a daily electronic log kept by the Wound Team APN's.  There has been a 30% reduction in device-related PUs since implementation three months ago along with increased partnership with Nursing Quality, Patient Safety, and Performance Improvement departments to support this initiative.