The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

SKIN PREPARATION PROCESS FOR THE PREVENTION OF SKIN BREAKDOWN IN PATIENTS WHO ARE INTUBATED AND TREATED WITH ROTOPRONING

Mary Ellen Jackson1, Joell X. Verano2, Anthony P. Rodriguez1, Jill E. Fry1; 1Respiratory Care, University Medical Center at Brackenridge, Austin, TX; 2WOCN, University Medical Center at Brackenridge, Austin, TX

Background: While performing QI of Respiratory Care device related issues in UMCB-ICU, we encountered problems such as, redness, breakdown, and pressure ulcers due to airway devices. Interventional care steps began with RT Skin Champions and WOCN to develop best practice for skin preparation processes addressing the issues of skin breakdown, redness, and pressure ulcers relating to all RT devices. Further work was done regarding rotoprone patients following a severe deep tissue injury to the face of a patient caused by a RT device. A new preventative care plan specific to rotoprone patients was initiated. The purpose of the new process was to find a method of securing the endotracheal tube in the rotoproning patient while minimizing or preventing the incidence of pressure ulcer and breakdown of the face and lips. Also an interventional care plan was initiated if any redness or breakdown occurred. Case Summary: The initial case study patient was a 26 year old female admitted with respiratory distress, cough, fever, body aches and nausea for 5 days. Her diagnosis was Community Acquired Pneumonia and Acute Respiratory Distress Syndrome. On 9-9-2009, at UMCB ICU the initial case study patient was placed on the rotoprone bed and the endotracheal tube was secured with an oral endotracheal tube fastener. On day #5, 9-14-09, a deep tissue injury had occurred to the patientÂ’s bilateral cheeks due to pressure exerted by the oral endotracheal tube fastener. Discussion: Following the use of the preventative and interventional steps outlined, there has been a good outcome for the skin on the cheeks and lips of six rotoprone patients following the initial case study patient. Analysis results shared with Network S.K.I.N. Team comprised of WOCN, Respiratory Care, Registered Nurses and Seton Network Patient Safety Project Management Consultant, Clinical Quality and Patient Safety Skin Team. Trial Process was accepted at the Seton Network S.K.I.N. Team and Respiratory Care Clinical Practice Group. Changes were implemented and the spread of Best Practice across the Network to all nine Austin Area Seton Family of Hospitals. Wound Assessment /Care site built to include Respiratory Care as a Discipline Managing Wound Assessment and Wound Care. Documentation on the computer site will be multi-disciplinary to include Nursing, Physical Therapy, Occupational Therapy, Wound Ostomy Continence Nurse and Respiratory Care. Sponsored Research - None

Deep tissue injury after five days of rotorproning caused by RT device