Decreasing Tracheostomy Associated Hospital-Acquired Pressure Injuries in Critical Care and Step-Down Units
Poster Abstract Submission
SAWC/Spring 2018
Information/Educational Report
An Evidence Based Practice Initiative
Julie Rivera MSN, RN-BC, CWOCN, Erin Donohoe BSN, RN, CWOCN,
Renee Murray-Bachmann Ed.D, MSN, RN, CDE, Seon Lewis-Holman DNP, RN, ACNS-BC
Lenox Hill Hospital, New York, NY
Title
Decreasing Tracheostomy Associated Hospital-Acquired Pressure Injuries in Critical Care and Step-Down Units
Category of Submission
Information/Educational Report: An Evidence-Based Practice Implementation Project
Background/Significance of Project
Patients on critical care units frequently require tracheotomies. The resulting tracheostomy places patients at risk for medical device-related pressure injuries. These patients are often transferred to a step-down unit with the tracheostomy in place.
The purpose of this evidence-based practice initiative was to reduce the incidence of hospital-acquired pressure injuries related to a tracheostomy. A root cause analysis identified the lack of consistency by staff pertaining to skin protection beneath the tracheostomy plate.
Research/PICO Question
(P) Patients with tracheostomies at risk for pressure injury
(I) Application of thin silicone dressing beneath tracheostomy plate
(C) Lack of standardized dressing
(O) Decrease tracheostomy-associated, hospital-acquired pressure injuries
Evidence Summary
The literature review included Pub Med, Cinahl and Clinical Practice Guidelines.
Methods/EBP Change Implemented
Following review of the literature, the decision was made to routinely use a thin silicone dressing beneath the tracheostomy face plate. In addition, the timely removal of the sutures (when applicable) was discussed with the physicians responsible for creating the tracheostomy.
Levels and Strength of Evidence
The levels and strength of evidence were assigned as outlined in the National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP), and the Pan Pacific Pressure Ulcer Alliance Clinical Practice Guidelines and are noted within the citations in the bibliography.
Outcomes
Implications for Practice
Eleven months following implementation of the EBP initiative, there were 3 incidences of tracheostomy-related hospital acquired pressure injuries.
Post HAPI RCAs revealed the thin silicone dressing was not placed beneath the tracheostomy plate or was placed incorrectly.
Sustainability Plan
Sustainability of the initiative was promoted by creating poster boards with step-by-step instructions for application of the silicone dressing. The posters were placed on every unit for reference and reinforcement.
Dissemination Plan
Information was disseminated through meetings with physicians who perform tracheotomies and through in-services for staff and interdisciplinary leadership.
Conclusions
Pre-EBP initiative, there were 8 tracheostomy-associated HAPIs from 1/2016-12/2016 and 3 post initiative from 1/2017-11/2017, demonstrating a 62.5% decrease in tracheostomy-associated HAPIs.
Post HAPI RCAs revealed staff did not apply the dressing or applied it incorrectly.
