![[ Visit WOCN Website ]](images/banner.jpg)
In 2016, a critical care unit in the mid-Atlantic region observed an increased number of pressure injuries (4) in patients using continuous/intermittent CPAP/BiPAP. The delivery of high-pressurized oxygen and overall status placed patients at risk for pressure injuries. Patient dependency on the high-pressurized oxygen results in nurse reluctance to remove the mask and consequently, a partial or incomplete skin assessment. The purpose of this work is to reduce the number of patients with hospital acquired pressure injuries (HAPI) resulting from the use of CPAP/BiPAP therapy.
Methods. An interdisciplinary team was created to assess, evaluate current state, and implement strategies for improvement. The team developed standard work for patient management, created a daily key process indicator (KPI) and evaluated outcomes. With evidence of blanchable redness at the time of assessment, the nursing staff initiated the use of thin foam under the mask for pressure redistribution. Nurse training by the respiratory staff included initiating standby mode and mask removal to allow for facial skin assessments. A new BiPAP/CPAP mask, with an under the nose mask cushion for pressure reduction, was trialed. A debrief tool was developed to use when a patient was identified with evidence of facial skin breakdown.
Results. Through active collaboration, the interdisciplinary team implemented standard work, completed product evaluation and monitored key process indicators. As a result of this work, the critical care unit has noted a decrease in pressure injury incidence YTD. Since January 2017, there has been one identified HAPI related to BiPAP/CPAP masks.
Conclusion. Improved compliance in mask removal for skin assessment has been achieved through staff education. Early intervention and the use of the new mask have led to a decrease in progression of the redness under the mask to stageable pressure injuries.