A short-term effort to prevent facial pressure injuries quickly demonstrated the initiative’s potential impact and led to institution-wide adoption of different types of noninvasive oxygen delivery devices.
“Prevention of Medical Device-Related Pressure Injuries Due to Noninvasive Ventilation Masks and Nasal Cannulae” details the results of a quality improvement initiative in four adult inpatient units at Nebraska Medicine, a medical center Affiliated Scholar at the University of Nebraska Medical Center, Omaha. The project included a COVID-19 intensive care unit (ICU), a surgical ICU, a reduced critical care unit and a medical-surgical COVID-19 unit, for a total of 75 hospital beds. The article is published in the October issue of Critical Care Nurse (CCN).
The main intervention in the study was the transition from the use of a single over-the-nose non-invasive oral-nasal ventilation mask to a single-auricular, interchangeable under-the-ear non-invasive oral-nasal ventilation mask nose and on the nose. Polyvinyl chloride nasal cannulas were also replaced with soft cannulas.
In addition, the initiative introduced a mask rotation schedule in the units, specifying that non-invasive ventilation masks are rotated every four hours. Hydrocolloid dressings used under the masks were stored in easily accessible locations and packaged with noninvasive ventilation machines to provide convenient access to the initiation of oxygen delivery.
During the 60-day study period in November and December 2020, units reported no medical device-related pressure injuries in patients who were using the trial devices, compared with five during the pre-intervention period of 60 days and two in patients who were not switched to the test devices during the study period.
Co-author Kaitlyn Duerst, DNP, APRN, AGACNP-BC, CCRN, is a critical care nurse practitioner at Nebraska Medicine, Omaha.
In addition to the decrease in the number of pressure injuries, patient feedback supported the full adoption of the trial devices. Patients told nurses that the softer nasal cannula put less pressure on their ears and that they preferred the new non-invasive under-the-nose ventilation masks compared to the over-the-nose types that are standard in most the institutions”.
Kaitlyn Duerst, nurse practitioner, critical care medicine, Nebraska Medicine, Omaha
The initiative used several evidence-based interventions concurrently, including providing collaborative education to nurses and respiratory therapists, establishing a schedule to alternate noninvasive ventilation masks every four hours, and proactively applying preventative dressings.
Co-author Austin Clark, DNP, APRN, AGACNP-BC, is also a nurse practitioner at the hospital.
“Pressure injuries have long been a problem in health care, and it really takes an interdisciplinary team working together to solve the problem,” Clark said. “Our project demonstrates that it is possible to package these individual evidence-based practices into a single intervention that can be replicated at other institutions.”
The initiative took place during the delta surge of COVID-19 in late 2020, which affected staffing levels and patient census, including the number of patients receiving non-invasive oxygen. Two of the four trial units were COVID-19 units, allowing the team to compare results through the lens of the pandemic. More nasal cannulas were used in the COVID-19 medical surgery unit, but more non-invasive ventilator masks were used in the COVID-19 ICU, compared to their pre-COVID-19 numbers.
The study authors, with assistance from the academic medical center, developed an online education module within the hospital’s existing educational platform. The module included information on how to properly use and care for trial devices, associated medical history requirements, and information on preventing pressure injuries in patients using these devices. Nurses and respiratory therapists working in the study units were assigned to complete the educational module prior to implementation.
Although too small and too brief to be statistically significant, the results demonstrated the potential impact of the initiative and the institution now uses the test devices for all non-invasive masks and nasal cannulas.
As the American Association of Critical Care Nurses’ bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically ill patients.
Source:
American Association of Critical Care Nurses
Journal reference:
Duerst, J., et al. (2022) Prevention of medical device-related pressure injuries due to noninvasive ventilation masks and nasal cannulas. Critical Care Nurse. doi.org/10.4037/ccn2022783.