Decreasing Pressure Injury from Endotracheal Tubes and Stabilization Devices with Multidisciplinary Team Approach

 

Abstract

Purpose: Respiratory devices can cause medical device related hospital acquired pressure injury (HAPI). This evidence based quality improvement was aimed to decrease device related HAPI from endotracheal tubes (ET) and ET stabilization devices.

Background: In 2014, in the critical care units of an academic suburban medical center, the incidences of HAPI secondary to ET and ET stabilization devices was 0.79/1000 ventilator days which increased in 2015 to 1.72/1000 ventilators days. The cumulative HAPI rate for 2014-2015 was 1.26/1000 ventilator days.

Methods: Define, Measure, Analyze, Improve, and Control (DMAIC) performance improvement methodology was utilized by a multidisciplinary team (respiratory manager, respiratory therapists, wound ostomy continence nurse, registered nurses, information technology, anesthesia staff, medical director, nurse manager and educator) to address this challenge. Improvement initiatives implemented in January and February of 2016 included process standardization using the ET securing device with visual cues, electronic prompts, multimedia education, dermal rounding, process auditing with peer coaching, return demonstration competency assessments, cross discipline training and defined quality metrics tied to employee performance pay.

Results: The improvement goal to reduce HAPI by 50% over the baseline and have a 90% process compliance rate was achieved. Significant improvement resulted with the HAPI rate decreasing from the 2014-2015 1.26 baseline to 0.34/1000 ventilator days during the ten month period following the implementation phase in 2016. Improvements were sustained with no incidences in 2017.  January through September 2018 one HAPI yielded a rate of 0.19/1000 ventilator days.

Conclusions: This DMAIC project utilized a systematic approach to clearly define the process to dramatically decrease ET tube and ET stabilization device related HAPI. With highly standardized guidance and a multidisciplinary team approach, the control plan was designed to assure ongoing success by conforming to a well-defined evidence based practice.