The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

PREVENTING AND TRACKING NON-INVASIVE VENTILATION (NIV) INTERFACE RELATED PRESSURE ULCERS AS A QUALITY MEASURE.

Dave N. Crotwell1, John W. Salyer1, Sharon Neilsen2, Leslie Plouse-Nixon2; 1Respiratory Therapy, Seattle Children's Hospital, Seattle, WA; 2Nursing Services, Seattle Children's Hospital, Seattle, WA

Introduction: In Washington state hospitals are required to report all stage 3 and 4 pressure ulcers to the Washington state Department of Health (DOH). NIV mask/prong related pressure ulcers fall under the category of device related pressure ulcers within the Washington DOH. If we report a device related pressure ulcer to the DOH, then we must do a thorough case review and submit an action plan to the DOH. Regular tracking of NIV mask/prong related pressure ulcers is currently used as a measure of clinical quality and patient safety in our hospital setting. In this abstract we report the methods and results of our program to measure and manage NIV related pressure ulcerations. Methods: NIV related pressure ulcerations are reported by bedside personnel via an electronic incident reporting system. Following this, NIV related pressure ulcers are tabulated for each quarter and indexed for each 100 NIV days in the hospital ([ Pressure Ulcers/NIV Days] x 100). These rates are compared quarter by quarter using ourselves as the benchmark, since there is no national data base currently tracking this metric. These findings are reported to the medical and nursing leadership of the various units. We report data for the period from 1st quarter of 2010 to the 1st quarter 2011. Results: Results are displayed in the graph below. Conclusion/Discussion: Our Respiratory therapists collaborate with nursing and utilize standard pressure ulcer prevention techniques before NIV therapy begins and continue to conduct regularly scheduled skin integrity checks. We conclude that our decreasing rate of NIV related pressure ulcers is related to several factors; 1) Standardized pressure ulcer prevention, 2) RT and nursing clinicians diligent attention to assessment of skin integrity during NIV system checks. We believe that the importance of device related pressure ulcer prevention will become more evident as the use of NIV continues to increase. We recommend that NIV mask/prong manufacturers begin to package skin protection with al their NIV interfaces to improve compliance with skin protection.
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