Prevention of medical device-related pressure injuries in critically ill patients: a quality improvement project

Purpose: Medical device related pressure injuries (MDRPIs) occur as a result of devices designed and applied for diagnostic or therapeutic use. Pressure injury development increases hospital length of stay, mortality rates and costs related to treatment. Patients admitted to intensive care units are 2.4 times more likely to develop pressure injuries due to severity of illnesses, presence of comorbidities and the presence of medically necessary devices. This Doctor of Nursing practice project examined the impact of an evidence-based bundle of nurse-driven interventions to reduce the prevalence of MDRPIs in critically ill adults, with a focus on cervical collars, tracheostomy face plates, and tracheostomy ties. Methodology: This was a quality improvement, pre-and post-implementation design. Patients 18 years of age or older, admitted to the surgical intensive care unit with either a cervical collar or tracheostomy tube, or a patient that received one of these medical devices at any time during the specified period were included. Study participants received a bundle of interventions to prevent pressure injuries related to these medical devices that included: standardized skin assessment and documentation related to the device; application of prophylactic foam dressings in areas where medical devices were in use; standardized evaluation of need and timely removal of cervical collars; use of soft foam tracheostomy ties; and timely suture removal at tracheostomy site. Prevalence rates pre and post intervention were compared. Results:Thirty-one (31) patients were included in the study. There was no reported MDPRI related to cervical devices or tracheostomy plates or ties in the post intervention period. Findings demonstrated greater than 90% compliance with five of the seven bundle components. Implications for Practice: This project introduced an evidence based, standardized bundle of interventions which increased awareness of prevention efforts, and enhanced patient care and safety in the Surgical Intensive Care Unit. Continued monitoring of MDRPI rates, ongoing education and feedback for staff is needed to sustain awareness of the importance of PI prevention and positively affect prevalence rates.D.N.P.Includes bibliographical reference