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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)
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