larry kula denise nix vicki haugen
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Pressure Ulcer Prevention - Respiratory Devices. Larry Kula Denise Nix Vicki Haugen. www.mnhospitals.org. Minnesota AHE Reporting. Mandatory state reporting system NQF 28 Serious Reportable Events Serious pressure ulcer reportable Stage III, IV and Unstageable. - PowerPoint PPT PresentationTRANSCRIPT
Larry Kula
Denise Nix
Vicki Haugen
Pressure Ulcer Prevention - Respiratory
Devices
www.mnhospitals.org
Minnesota AHE Reporting
Mandatory state reporting system NQF 28 Serious Reportable
Events Serious pressure ulcer reportable
Stage III, IV and Unstageable
Reported events, Oct. 2008-Oct 2009
301 Events
4 Deaths
Retained objects
38 Wrong site surgery
27Wrong
procedure15
Pressure ulcers122
Other 19
Medication Errors
4
Falls76
Stage III, IV, Unstageable Pressure Ulcers Submit RCA/CAP
Additional information Patient Characteristics Pressure Ulcer Development Additional Patient Questions Device-related Questions Surgery/Procedure Questions
Pressure Ulcer – Added Qs
Last year, 25% of reportable pressure ulcers were device-related.
Majority of devices involved were cervical collars and respiratory devices.
Types of Pressure Ulcers
Case Examples Stage IV pressure ulcer behind the ear
from oxygen tubing. Skin inspection behind ears not completed; early redness
not communicated when seen. Stage III pressure ulcer under
tracheostomy device. Skin under tracheostomy device not inspected on a
regular basis. Stage III pressure ulcer on bridge of
nose from BiPap mask. Staff not aware of mask alternatives for high-risk patients
or most effective strategies for reducing pressure under masks.
Statewide approach to implementing best practices
Roadmap of Best Practices Additional Recommendations added
this year based on AHE learnings: Pressure Ulcer Prevention in the OR Device-related Pressure Ulcer Prevention –
Cervical Collars Device-related Pressure Ulcer Prevention –
Respiratory Devices
Safe Skin Call-to-Action
What’s in it?
Device-Related Pressure Ulcer Prevention
Respiratory Devices
Recommendations and Guidance
Member of Skin Safety Team Types of involvement:
Involvement in developing policies to prevent respiratory device-related pressure ulcers
Regular education and training of respiratory staff on pressure ulcer prevention; partner with wound care staff for training, grand rounds, etc.
Process to consider skin safety when purchasing respiratory equipment
Involvement in root cause analyses when pressure ulcer involving respiratory equipment occur
Role of Respiratory Therapy
Skin Inspection
RespiratoryDevice
InspectionsFrequency
InspectionLocations
Nasal Cannula Q shift 8-12 hrs Back of ears
Mask During oral Cares Back of earsBridge of nose
Tracheostomy Q shift 8-12 hrs NeckUnder face plate
ETT Q 2 hrs (During Oral Cares)
NeckLips/face
Secure straps with least amount of tension/pressure to obtain adequate placement/seal.
Consult with respiratory therapy for proper re-fitting at first sign of skin damage
Consider utilizing alternative product such as full face masks or those that incorporate gel or silicone based cushions if standard equipment cannot be sized and adjusted to avoid skin breakdown.
Device Fit
Visually inspect masks and tubing on a regular basis.
Replace if straps lose elasticity, become soiled, or defective.
Do not tie knots in straps to tighten.
Device Inspection
Commercially available ear protectors to attach to oxygen tubing.
Oxygen tubing with protectors pre-attached
Foam tracheostomy straps designed to hold oxygen cannula away from the ears.
Commercially available foam/collar type adjustable straps are preferable to traditional methods (tape/twill ties) of securing trachs and ETT (AHA Guidelines)
Tips to Minimize Friction/ Pressure(websites, references, photos)
Silicone stoma pad (cushion between the flange and the tracheostomy site) for pressure redistribution
A ventilator arm and rolled towel to the chest to offload pressure and drag of ventilator tubing.
Gel pads sold separately or incorporated into masks
Application of wound dressings over vulnerable or affected area (dressings reduce friction-not pressure; continue routine skin inspection
Tips to Minimize Friction/ Pressure(websites, references, photos)
Create standard procedure and timeline for management of tracheostomy sutures.
If standard timeline is not in place, contact the surgeon/provider after 7-10 days or sooner if skin irritation near the sutures occurs.
During hand-off to next level of care, include instructions for converting from suture stabilization to other means for securing and stabilizing flange.
Trach Sutures
Neonatal/Pediatric: Pediatric pressure ulcers occur primarily on the
head/occipital region. More than 50% of all pediatric pressure ulcers are
related to equipment and devices . Use commercially available pediatric products when
available rather than adapting standard equipment. Specific interventions intended for adults may NOT be
safe for neonatal and pediatric patients (i.e. rotating ETT); always follow pediatric specific recommendations and manufacturers’ instructions when available
Special Populations
Bariatric: Pressure ulcers from respiratory equipment can
result from pressure within skin folds. Consider use a of silver textile product to wick
away moisture from skin folds. Instead of adapting standard equipment, use
commercially available bariatric products such as longer tracheostomy tubes and bariatric tracheostomy collars.
Special Populations