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§  EstablishedaninterprofessionalteamtoaddressthegapsinknowledgeandinconsistenciesincareamongRNandRTstaff

§  Evaluatedthecurrentprac<cestandardsintheassessment,management,anddocumenta<onofpa<entsrequiringarespiratorydeviceincri<calcare

§  EducatedRNandRTstaffoncarestandardstopreventrespiratorydevice-relatedpressureinjuries

§  Educa&on&psheetsoutliningstandardsofskincare(Figure1&Figure2)§  Heldindividualandgroupin-services§  Ini&atedsimultaneousRT/RNcollabora&veskinassessments

§  Improvedcomplianceofdocumenta<onforpa<entswithNIPPVmasksandETTholders

§  Developedanaudi&ngtooltomeasuredocumenta&oncompliance(Figure3)

§  RandomchartauditsinQ2-2016throughtheendofQ4-2016

§  Real-&mefeedbackregardingtheirdocumenta&oncompliance

§  Unitmonthlypressureinjuryincidenceratesweremonitoredandrecordedinaunitlogbook

INTERVENTIONS

RespiratoryDevice-RelatedPressureInjuriesinCri<calCare

SETTINGNewYorkUniversityLangoneMedicalCenter

TischHospitalNewYork,NY

§  725-BedAcute-CareTer&aryFacility§  AcademicMedicalCenter§  18MedicalICUBeds§  9SurgicalICUBeds§  Magnet®Recognized

§  Evaluatethecurrentprac&cestandards

§  Designandimplementcarestandardstoprevent

respiratory-MDRPIs

§  Educatenursing(RN)andrespiratory(RT)staffon

carestandardsofpreven&on

§  Improvecomplianceofdocumenta&onfor

respiratorydevices(Goal>80%)

§  ReducetheMICU’sRDRPIincidencerateby50%in

Q2-2016,withthelong-termgoalofzeropressure

injuriesinQ3andQ4.

RESULTSRespiratoryDevice-RelatedPressureInjuryIncidence

§  98%ofRNandRTstaffwereeducatedduringQ1-2016usingthedevelopededuca&onsheets(Figure1&Figure2)

§  RDRPIincidenceratereducedby50%inQ2-2016(GraphB).

Documenta<onCompliance

§  Randomchartauditswerecompletedtwiceperweek(30perquarter)usingtheaudi&ngtool(Figure3)

§  24-hourperiodofdocumenta&onaudit

PURPOSE&GOALS

OUTCOMES

§  MDRPIsarecommoninICUpa&entsandmustbeclosely

monitored

§  NIPPVmasksandETTholdersplacethepa&entatan

increasedriskfordevelopingMDRPIs

§  Standardizedcareandinterprofessionalcollabora&onis

importantinthepreven&onandmanagementofRDRPIs

§  On-goingeduca&onforbothnewandcurrentstaffis

impera&veinthepreven&onofRDRPIs

REFERENCES1.  Krupp,A.&Monfre,J.(2015).PressureulcersintheICUpa&ent:Anupdateon

preven&onandtreatment.CurrentInfec+ousDiseaseReports,17(3),1-6.

2.  Cooper,K.(2013).Evidence-basedpreven&onofpressureulcersintheintensivecareunit.Cri+calCareNurse,33(6),57-66.

3.  Apold,J.&Rydrych,D.(2012).Preven&ngdevicerelatedpressureulcers:Usingdatatoguidestatewidechange.JournalofNursingCareQuality,27(1),28-34.

4.  Baharestani,M.(2013).Medicaldevice-relatedpressureulcers:Thehiddenepidemicacrossthelifespan.Presentedatthe13thNPUAPNa&onalBiennaConferenceDTI:TheStateoftheScienceinHouston,Texas(2/22/2013).

5.  Na&onalPressureUlcerAdvisoryPanel,EuropeanPressureUlcerAdvisoryPanelandPanPacificPressureUlcerAlliance(2014).Preven&onandtreatmentofpressureulcers:Clinicalprac&ceguideline.EmilyHaesler(Ed.)CambridgeMedia:OsbornePark,Australia.

§  RalphCarumba,MS,RN,CCRNAssistantNurseManager,MedicalICU(NYULMC)

§  CharlesCatanzaro,RRTDirectorofRespiratoryTherapy(NYULMC)

§  JosephineC.Garcesa-Duque,MSN,CCRN-KNursingEduca&on,Cri&calCare&Hemodialysis(NYULMC)

§  CatherineManley-Cullen,MS,RN,CENSeniorDirectorofNursing,Medicine&EmergencyServices(NYULMC)

§  WalterPagan,BSN,RN,CCRN,CENNurseManager,MedicalICU(NYULMC)

ACKNOWLEDGEMENTS

GraphB:DepictsthequarterlyRDRPIincidenceratesfor2016.

2.10%

0.70%

0%

0.50%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

Q1 Q2 Q3 Q4

Incide

nce(%

)

Quarter

2016QuarterlyMICURDRPIIncidence(%)

RDRPIIncidence(%)

GraphC:Depictstherawnumberofpressureinjuriespermonth.RDRPIincludesonlyinjuriescausedbyETTholdersorNIPPVmasks.

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

RDRPI 1 2 6 3 0 0 0 0 0 0 2 0HAPI 1 5 8 7 0 2 0 2 0 0 4 4MDPRI 1 5 7 5 0 2 0 2 0 0 3 3

1

2

6

3

0 0 0 0 0 0

2

0

1

5

8

7

0

2

0

2

0 0

4 4

1

5

7

5

0

2

0

2

0 0

3 3

0

1

2

3

4

5

6

7

8

9

#ofPressureInjurie

s

MICUPressureInjuryIncidence2016Q1-Q4

RDRPI

HAPI

MDPRI

ProjectImplementa<on

§  CY15MICUhad6MDRPIs

§  Q1-2016MICUhad12MDRPIs,9causedby

respiratorydevices(2.1%incidence)

§  Addresstheriseinrespiratorydevice-relatedpressure

injuries(RDRPI)fromNIPPVmasksandETTholders

PROBLEM

84%

90%

81%

63%

84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Quarter2 Quarter3 Quarter4

MICU2016Documenta<onComplianceforETT&NIPPVMasks

ETT

NIPPV

GraphD:Documenta&oncomplianceforETTholdersandNIPPVmasks.Metgoalof>80%ETTholderdocumenta&oncomplianceforeachquarter.NIPPVmaskdocumenta&oncompliancemetinQ4.Nopa&entswithNIPPVmaskswere

randomlyauditedinQ3.

§  MICURDRPIincidencedecreasedby50%inQ2-2016

andhadZERORDPRIduringQ3-2016

§  MICUmaintained>80%documenta&oncompliancefor

pa&entswithETTholderseachquarter

§  NIPPVmaskdocumenta&oncomplianceimproved

eachquarterandmetthecompliancegoalof>80%in

Q4-2016

§  ExpandedtootherunitswithinNYULMC

§  UpdatedNYULMCrespiratorycarestandard

Interprofessionalteambuildingandshared

Figure1:NIPPVMaskEduca&onSheet

Figure2:ETTHolderEduca&onSheet

Figure3:ChartAudi&ngTool

CONCLUSIONS

NewYorkUniversityLangoneMedicalCenter(NewYork,NY)|Hunter-BellevueSchoolofNursing(NewYork,NY)

AnneUrquhart,BSN,RN,CCRN,BarbaraSuggs,BSN,RN,MagalieBloncourt,BSN,RN,CCRN,GabrielleRiswold,BSN,RN,CCRN,MargotStluka,BSN,RN,&ElizabethSavage,MSN,APRN,ACNS-BC,CWON

0

2

0

1

6

7

0

2

0

1

56

0

1

2

3

4

5

6

7

8

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

#ofPa<

ents

MICUHAPIINCIDENCE2015Q4–2016Q1

HAPIs Device-RelatedHAPUs

GraphA:MICUHospitalAcquirePressureInjuryIncidencetrend(Q1,2015–Q1,2016)