Protective elements of a foam dressing may benefit other patients, as well, a new study says.
By adopting a revised clinical process and using a polyurethane foam dressing, a New York City hospital reduced the incidence of medical device-related pressure injuries (MDRPIs) following a tracheostomy to zero for four years, according to a study published in AACN Advanced Critical Care.
Reducing Tracheostomy Medical Device-Related Pressure Injury: A Quality Improvement Project details how NewYork-Presbyterian Westchester, in Bronxville, achieved the results in its 18-bed adult intensive care unit (ICU), by, in part, integrating MDRPI prevention into the bedside procedure for tracheostomies that used the percutaneous dilation technique (PDT).
About 2.5 million patients experience hospital-acquired pressure injuries (HAPIs) each year, costing about $11 billion, according to the study. Nearly 24% of those incidents occur in ICU patients, as compared to up to 18% among general admission patients.
MDRPIs associated with a tracheostomy account for up to 10.9% of hospital-related incidents, the study notes.
NewYork-Presbyterian Westchester’s quality-improvement initiative used evidence-based resources from the Preventing Pressure Injuries Toolkit funded by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.
A key part of the new process was a revised PDT tracheostomy procedural kit and documentation, with the foam dressing placed under the tracheostomy flange during insertion. Both were secured with sutures and a flexible holder.The foam dressing remained in place for seven days, with primary care nurses assessing the site at least every 12 hours, the study says.
The dressing was then changed to a standard nonwoven gauze drain sponge after seven to 10 days as clinically instructed.
The results showed that suturing a foam dressing as part of PDT tracheostomy insertion can reduce the incidence of associated MDRPIs.
"When COVID-19 increased demand for healthcare equipment, we were able to refine our processes, transition to a revised PDT tracheostomy kit and maintain the integrity of the initiative," says Hazel Holder, DNP, MSN, RN, ACCNS-AG, CCRN, a critical care clinical nurse specialist and study co-author.
"We took a multidisciplinary approach that engaged all related specialties, with surgical site assessment and any clinician concerns discussed during daily rounds," says Holder, who conducted the study with Brittany "Ray" Gannon, PhD, MSN, AGPCNP-BC, a nurse scientist.
Prior to the initiative, in 2018, the incidence of HAPIs at the hospital was 1.39% for all ICU patients, with tracheostomy MDRPIs accounting for 0.19% of the incidents—15 HAPIs, including two MDRPIs in 1,077 patients. Of the two PDT tracheostomies performed, both patients experienced MDRPIs.
In 2019, the overall HAPI incidence decreased to 1.30%, with nine tracheostomies and no MDRPIs. The tracheostomy MDRPI incidence remained at zero for the next three years.
During the four years of this project, a total of 22 PDT tracheostomies were performed in the ICU, with the foam dressing placed at the point of insertion in all procedures.
That placement of the foam dressing can reduce the incidence of tracheostomy MDRPIs, and may benefit other patients as well, the study concludes.
“Although some process modifications may be necessary, the protective elements of the polyurethane foam dressing may benefit other patient populations as well,” the study says, “including pediatric, neonatal, and surgical.”
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.
KEY TAKEAWAYS
MDRPIs associated with a tracheostomy account for up to 10.9% of hospital-related incidents.
The new process involved foam dressing placed under the tracheostomy flange during insertion.
During the initiative’s four years, 22 PDT tracheostomies were performed, with no MDRPIs.