Device Related Pressure Ulcers Pre and Post Identification and Intervention

Problem: From2014 to 2016, device related pressure injuries accounted for 62-81% of all hospital acquired pressure injuries. From January to June 2014, there were 5 BiPAP/CPAP pressure injuries noted, accounting for 3.579 injuries per 1000 ventilator days. In 2015, hospital data revealed that 26.5% of all hospital acquired pressure injuries occurred to prone surgical spine patients. Methods: Collaborative teams including respiratory therapists and operating room staff were convened and crafted new strategies. 1 Interventions: Adhesive foam dressings on patient faces with BiPAP/CPAP masks and prior to orthopedic spinal surgery were used to prevent device and operating room positioning pressure injuries. Results: From July to December 2014 there were 0 BiPAP/CPAP pressure injuries. After interventions inMarch of 2016 through the remainder of 2016, zero pressure injuries occurredwhen the adhesive foamdressingswere applied to the potential pressure injury areas pre-operatively. Conclusions: We used real time patient data to drive efforts and create a new culture in the pediatric setting that honors critical airway maintenance, operative room positioning, and preventative skin protection. (C) 2018 Elsevier Inc. All rights reserved.