Hospital acquired pressure ulcers in the United States have declined over the past decade. However, during this same period medical device related pressure ulcers have increased across the country. This same phenomenon has been witnessed at a suburban Philadelphia level II trauma center. Monthly prevalence and incidence studies at the institution revealed that the vast majority of hospital acquired pressure ulcers were caused by medical devices, most notably cervical collars, tracheostomy flanges, arterial line splints and BiPap masks. A process improvement team consisting of dermal defense champions, the educational team of the intensive care unit, and respiratory therapists initiated a literature search and developed strategies to eliminate this trend. A standard of care was developed for patients with a cervical collar: two nurses stabilize the patient’s cervical spine while removing the collar, skin inspection is done, any reddened areas are noted and a silicone foam adhesive dressing is applied. This skin inspection is completed twice daily. A silicone foam adhesive dressing is applied to the web space of the hand prior to application of the arterial line splint. Skin beneath this dressing is inspected twice daily as well. A similar technique is used to protect bony prominences beneath a BiPap mask. The respiratory therapist partners with nursing in order to ensure skin inspection occurs every two hours beneath this device. The respiratory therapist also partnered with the trauma surgeons and physician assistants in order to eliminate suturing the tracheostomy tube flange to the skin, thus enabling good skin care and the ability to place a foam dressing beneath the flange if necessary. These interdisciplinary collaborations, along with rounding in the intensive care unit, has increased awareness that these ulcers are indeed preventable. This, in turn, has drastically reduced device related pressure ulcers to less than 1%.
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