Driving Down Trach-Related Pressure Injuries

Problem: Development of pressure injuries underneath medical devices is becoming increasingly prevalent in critically ill patients¹.  In one acute-care academic medical center in the mid-Atlantic Region, 40-45% of all pressure injuries are related to medical devices. Many pressure injuries develop underneath the faceplate of tracheostomy tubes in patients in an ICU who underwent an emergent or bedside tracheostomy.  Nurses attribute injuries to lack of pressure-relieving dressing usage. Dressing usage is often limited by tight suturing and unclear communication between nurses and pulmonary physicians resulting in delayed suture removal.

Objectives: To decrease TRPIs by:

1. Identify a dressing that effectively reduces pressure, moisture and contact between skin and trach faceplate

2. Improve communication between physicians and nurses

Methods: a group of key ICU stakeholders including nursing, physicians and a WOC Nurse convened and identified areas for improvement: 1) the available moisture-wicking dressing was disliked by physicians and therefore not being used; 2) standardization of trach care in this population

Outcomes:

1. The WOC Nurse acquired samples of several products. Physicians and nurses identified a highly absorbent polyurethane tracheostomy dressing as the preference for use at time of(?) insertion and for continued care.

2. A Clinical Nurse III developed a communication form to be placed at patient’s head of bed to display pertinent care protocols and lines of communication.

Results: In the fiscal year (FY) 2015, there were eight TRPIs. There were also eight TRPIs within the first two quarters of FY2016. Upon implementation of above interventions, there was one TRPI in quarter 1 (Q1) and zero in quarter 2 of FY2016. There was one TRPI in Q1 FY2017.

Audits of use of bedside communication tool showed 100% compliance.