Decreasing Device Related Hospital Pressure Injuries in the Critical Care Unit: One Device at a Time.

Decreasing Device Related Hospital Pressure Injuries in the Critical Care Unit:   

One Device at a Time.   

AnnaMarie Anastasio RN,BSN.WCC 

Kathleen M. Boyle MSN,RN,CWOCN,AGPCNP-BC 

Annmarie Puliti RN,BSN,CCRN,WCC 

 

 Abstract 

Pressure injury prevention has become paramount across the landscape of Acute Care since the advent of CMS guidelines in 2008. This has proposed a challenge for hospitals to eliminate hospital acquired pressure injuries (HAPI).  According to Padula (2017)   34.5 % of hospitalized patients develop medical device related injuries.  Critical care patients are high risk populations due to comorbid conditions that contribute to pressure injury risk.   

In an East Coast community hospital, a dermal defense champions in the intensive care unit (ICU) identified an increasing incidence of device related pressure injuries. Multiple devices were identified as causative factors affecting the HAPI rate. The devices with the highest incidence were A-line tubing, Dobhoff tubes (DHT), Naso-gastric tubes (NGT), oxygen tubing, Endotraceal tube (ETT) securement and Bipap masks. An overwhelming quality improvement project at first, the ICU dermal defense champions decided to address one device at a time. After identifying specific devices that caused HAPI’s, the team created an action plan to address the increasing device related HAPI.  

  

The team consisted of three dermal team members, two wound care certified nurses and the hospital CWOCN. Staff was surveyed about current products and the application and maintenance of each product. After evaluating current practices and assessing for gaps in practice and knowledge, an education and implementation plan was developed. Education included inservices presented via email, one to one education, and group education. The increased awareness and extensive education resulted in the purchase of additional superior products and resulted in a 50% decrease in device related HAPI.