Abstract: Reducing Medical Device Related Pressure Injuries in the Intensive Care with Device Specific Bundles: Results of a 33-month Evidence-Based Practice Change (WOCNext 2019)

Susan Solmos, MSN, RN, CWCN¹, Cynthia LaFond, PhD, RN CCRN-K¹, Marianne Banas, MSN, RN, CCTN CWCN² and Jennifer Sala, ADN, RN³, (1)Center for Nursing Professional Practice and Research, University of Chicago Medicine, Chicago, IL, (2)University of Chicago Medical Center, ICU / Senior Skin Care Team Member, Chicago, IL, (3)University of Chicago Medical Center, Critical Care RN / Senior Skin Care Team Member, Chicago, IL

Purpose/Objective

To reduce hospital acquired medical device related pressure injury (HA-MDRPI) rates in the surgical and medical intensive care units (ICUs) by 50% through the implementation of device-specific prevention bundles.

Quality data indicated 50% of our pressure injuries were HA-MDRPI. The majority were secondary to five devices: endotracheal tubes, nasogastric tubes, bi-pap masks, nasal cannulas and sequential compression devices. The highest rates of HA-MDRPI occurred in our surgical and medical intensive care units (ICUs) with a mean rate of 4.8% (SD=4.1) during a 10-month timeframe.

Implemented Practice Change

We evaluated our high-risk devices to identify products designed to reduce HA-MDRPI. Preference was given to soft, flexible devices. In some instances we changed products or added additional sizes. General MDRPI prevention principles from the literature were identified including: skin assessment, device rotation/repositioning/resizing, protecting skin, and identifying patient specific risk factors. This bundle of interventions was tailored for each high-risk device. First, we included routine skin assessment beneath the device. Next, we paired the timing of repositioning/rotating/resizing with current nursing workflows when no specific recommendations were identified in the literature. Third, we included when to place dressings beneath the device to redistribute pressure and protect from moisture. Lastly, we identified patient specific risk factors, such as edema, which would affect the fit of the device and increase MDRPI risk. Bundles were piloted in the surgical and medical ICUs. Unit champions educated staff on the bundle use, with periodic reinfusion and audit of practices.

Evaluation Methods/Outcomes

Monthly prevalence surveys are conducted to determine HA-MDRPI rates. The HA-MDRPI rate in the surgical and medical ICUs decreased to a rate of 2.04% (SD=2.9) during the 8 month pilot and continued to improve for the 25 months following implementation. Overall, HA-MDRPI rates decreased 74% from a mean rate of 4.8% (SD=4.1) to 1.29% (SD=2.15) in 33-months.

ePI80 Reducing Medical Device Related Pressure Injuries in the Intensive Care with Device Specific Bundles: Results of a 33-month Evidence-Based Practice Change