Weekly ICU Rounds: Changing Nursing Practice to Prevent and Treat Medical Device Related Pressure Injuries (MDRPIs)

Topic:

MDRPIs are the result of sustained pressure from a device and the tissue injury conforms to the shape of the device. A correlation exists between medical devices and the development of MDRPIs, Edsberg and associates reported that 30% to 70% of MDRPIs resulted from respiratory equipment and are prevalent in ICUs. The goal of this preventative practice is to decrease MDRPIs in the ICU.

Purpose:

The primary purpose of this preventative practice is to raise ICU nurses’ awareness of MDRPIs and change the culture from reactive to proactive related to the prevention and treatment of MDRPIs. Aiming for zero harm and reduction of MDRPIs correlates to the hospital’s 2018 quality priorities. Additional goals include: increase awareness of factors leading to MDRPIs, foster interdisciplinary collaboration specific to device necessity & implement evidence based practices to prevent MDRPIs

Objective:

Heightened awareness fostered an initiative for MDRPI prevention in ICU. Utilizing an evidence based guideline tool, ICU Interdisciplinary Skin Rounds (SR) focusing on medical devices were initiated and completed weekly beginning January 2017. The (SR) included: chart review to determine co-morbidities and presence/necessity of medical devices; skin assessment of under medical devices; evidence of medical device rotation if applicable; facilitate the implementation of appropriate skin prevention and treatment utilizing hospital protocols by the RN. MDRPIs were discussed in morning huddles, weekly newsletter and SBAR handoffs. During daily interdisciplinary patient rounds discussion focused on the necessity of medical devices and their removal when medically feasible.

Outcomes:

Weekly rounds facilitated valuable information leading to practice improvements by care providers. Since the initiation of the Weekly ICU interdisciplinary (SR) there was one identified MDRPI. Multidisciplinary members endorse collaboration during rounds, additional heightened awareness for MDRPI prevention, removal and care. Sustaining continued success will be facilitated by continuing (SR) which fosters “in the moment” educational opportunities.