Larry Kula Denise Nix Vicki Haugen

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Larry Kula Denise Nix Vicki Haugen Pressure Ulcer Prevention - Respiratory Devices www.mnhospitals.org

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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 Presentation

Transcript of Larry Kula Denise Nix Vicki Haugen

Page 1: Larry Kula Denise Nix Vicki Haugen

Larry Kula

Denise Nix

Vicki Haugen

Pressure Ulcer Prevention - Respiratory

Devices

www.mnhospitals.org

Page 2: Larry Kula Denise Nix Vicki Haugen

Minnesota AHE Reporting

Mandatory state reporting system NQF 28 Serious Reportable

Events Serious pressure ulcer reportable

Stage III, IV and Unstageable

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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

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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

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Last year, 25% of reportable pressure ulcers were device-related.

Majority of devices involved were cervical collars and respiratory devices.

Types of Pressure Ulcers

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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.

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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

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What’s in it?

Device-Related Pressure Ulcer Prevention

Respiratory Devices

Recommendations and Guidance

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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

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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

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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

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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

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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)

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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)

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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

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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

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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