A Multidisciplinary Approach to the Prevention of Ear Pressure Ulcers

Project Aim

The aim of the project was to decrease the number of ear Hospital Acquired Pressure Ulcers (HAPU)  related to the use of nasal cannulas in the adult, acute population by at least 50 percent.

 Problem

A Hospital Acquired Pressure Ulcer (HAPU) is a negative outcome from a quality of life and financial reimbursement standpoint, and all healthcare providers play a role in protecting the patient from this adverse event.   “Skin Saver” team audits, provide a snap shot of pressure ulcer prevalence utilizing NDNQI criteria, are performed monthly within the organization.  Audits identified that greater than 25% of HAPUs occurred  over the ears related to the use of nasal cannulas.  The break down was accelerated by additional pressure from nasal cannula tubing, to an area that is already stressed by the continuous use of hearing aids and glasses. 

Actions

A multidisciplinary team, comprised of Skin Savers, Wound Care, Central Distribution, Nursing, Respiratory and Quality, convened to perform a FOCUS PDSA and formulate an action plan.  The analysis of the problem revealed that pressure ulcer development was the result of using rigid oxygen tubing.  A decision was made to trial the use of a soft silicone nasal cannula, on a designated nursing unit, and compare pressure ulcer prevalence to like units utilizing existing rigid plastic product. The action plan included staff education on appropriate nasal cannula application and the importance of daily assessment and early intervention.

Outcome

The trial resulted in a 100% decrease in the number of ear pressure ulcers on the designated unit. The product/process was implemented facility wide and throughout the Heath System.  Recent audits demonstrate a sustained 92.3% decrease in the hospital’s prevalence of pressure ulcers related to the ear over the past year.  Additionally, FOCUS PDSA became the template for future preventative strategies.